Aspectos que mejor describen el trabajo en grupo

By this stage of my research, the literature on use of focus groups with children to explore food, nutrition and health issues was increasing. Goodwin et al (2001) had used focus groups to develop a food and activity record and portion-size model booklet for use by US 6-17-year olds. Connors, Bednar and Klammer (2001) had used focus groups to study

cafeteria factors that influenced milk-drinking behaviours of US 6-11-year-olds. Eventually, I included a few questions similar to those asked in the latter study for comparative purposes.

3.2.4.1 Objectives

Children’s focus group interviews were conducted as a follow-up to the outcomes of Stages 2 and 3 of the research. Results from these two stages warranted further attention as they had either indicated promising or worrying trends from a nutrition and health perspective, or else they had suggested key factors which could impinge on children’s food intake.

Moreover, to maintain brevity and avoid superficiality, the Stage 3 quantitative tool had not

been used to probe for specific food-related themes which I was interested in (e.g. the influence of food attributes on intake). Thus, the focus group interviews would be used to explore these facets of children’s food intake as well. The main objectives of the focus group interviews are presented in Table 42.

TABLE 42

Main Objectives Of The Children’s Focus Group Interviews

• To uncover children’s perceptions of the health value of specific foods

• To uncover children’s perceptions of the prestige value of specific foods

• To explore children’s perceptions of different attributes of fruits, vegetables and milk which made these foods either more or less appealing

• To explore children’s attitudes and behaviours in relation to school milk provision and school food rules

• To explore children’s attitudes and behaviours in relation to school food rules

• To identify determinants of children’s exposure to particular foods

3.2.4.2 Choice Of Sample

Based on an analysis of the recommendations from different studies involving children’s focus groups, my main conclusions were that: homogeneity in the age of focus group members was important due to developmental issues; the ideal group size was of around five or six children (with a maximum of eight) in order to balance tape audibility with flowing discussion; the facilitator needed to ensure that there would be at least three ‘talkers’ in the group to guarantee high quality discussion (Hoppe et al., 1995; Wood Charlesworth &

Rodwell, 1997; Green & Hart, 1999). There was lack of consensus on gender composition, with some researchers recommending same-gender groups (Greenbaum, 1993; Hoppe et al, 1995) and others indicating that mixed-gender groups did not jeopardise ease of

communication (Wood Charlesworth & Rodwell, 1997; Green & Hart, 1999). I eventually had both set-ups due to the co-educational status of the schools used.

Table 43 gives an overview of the different features of the focus groups conducted in Stage 4. Sixteen focus groups were organised and purposive sampling was used to include schools from different regions and to meet with children attending state, church and independent schools, attending single-gender and mixed-gender schools, and attending schools which had or did not have a school food policy. Meeting with such a diverse group of children would increase the likelihood of exposure to the different lifestyles of Maltese children and allow me to tap different repertoires of knowledge. All the schools included in

123 TABLE 43

Different Attributes Of The Focus Groups

School Recruiter Origin of Group Duration

Setting Distractions Special Circumstances

Staff room High Room surrounded by classes and yard a In order of implementation

the sample had participated in the large-scale survey with Year 3 children the previous scholastic year. However, as the children chosen for the focus groups were mainly from the current Year 3 population none of them had been involved in the survey.

Schools are an environment where a hierarchy of gate-keepers may influence the sampling process and have unpredictable effects on the composition of the focus group. The

exclusion of children for one reason or other will likely bias the final sample of participants in a systematic way (Green & Hart, 1999). When I was planning my focus groups, it was still not the norm in Malta to obtain consent from parents before conducting research with children. Obtaining permission from the Education authorities and the Head of School sufficed. Following this standard procedure, I contacted the sixteen different schools speaking to one or more school administrators. None of the schools contacted declined to participate.

The participants for each interview were either recruited by the Head of School or the Assistant Head, or by the class teacher. Sometimes the children were from the same class and sometimes from different classes. Whilst setting up the interview appointments, some Heads of Schools asked me which criteria should guide them in their choice of interviewees.

Invariably, my reply was that if possible children should reflect a range of intellectual abilities and not be either excessively boisterous or timid. Speaking to some of the teachers after the interviews, a few of them explained their recruitment strategies. These included involving the

‘brighter’ or ‘more talkative’ children, ensuring a mix of abilities and in one case involving a child because he was overweight and the teacher thought the interview might influence him positively. Two interviews involved children with special needs (a hyperactive child and a child with a speech impairment). In both cases the child’s facilitator remained with the child for a short while and then left the interview room. One teacher explained how she had avoided showing favoritism during recruitment by telling the children that the list of

participants had been given to her by somebody else. These latter circumstances perhaps point to the way some Maltese schools endeavour to be inclusive at all levels.

Each focus group was made up of 6 children. In mixed-gender schools they consisted of three girls and three boys. There was one exception, as in one church school no Year 3 children were available and so older children from Year 2 who had celebrated their 7^th birthday were recruited. This resulted in a focus group comprised of four boys and two girls who were slightly younger than the rest of the sample groups.

3.2.4.3 Setting

Previous research had shown that the degree of formality of the context for the focus group sessions impinged on various aspects of the process, such as the relationship between facilitator and participants, explicitness of rules of conversation and smooth running of the session (Wood Charlesworth & Rodwell, 1997; Green & Hart, 1999). Where the session facilitator was perceived as an ‘honorary teacher’ it was easier to manage the discussion and children were more likely to control each other, to wait for permission to speak, or take turns to contribute to the conversation. Sitting in a circle around a table enhanced the output as children perceived this as symbolising an important and serious discussion. The

informality of sitting on the floor was considered to make the children feel more comfortable;

however, it also emerged as more conducive to distractions, such as arguments over violations of personal space. These different benefits and drawbacks were considered in the arrangements I requested for my focus groups, but the ideal situation was not always achieved.

I started each session by introducing myself and explaining how I could be addressed according to the norm in the respective school. In state schools the children tended to call me “Miss”. In church and independent schools they used “Miss Suzanne”. My introduction stated that they would be talking about food and that it was important that all of them

participated in the conversation. In one church school, the class teacher (a nun) encouraged the children “to be honest and speak up”.

Children were free to use whichever language they were comfortable with. Primarily, Maltese was used both by the children and myself. However, in the three independent schools the children preferred speaking in English and in the church schools some children spoke in English, others in Maltese. In three of the groups there was a foreign child. I asked these children about their comprehension of Maltese or English and then addressed them accordingly.

The physical location for the focus group interviews varied. With the exception of two locations, the interview sites were very private, ranging from vacant classrooms, to the school clinic. I had expressed this desire for privacy when setting up the appointments and most school administrators managed to oblige. In general, the children and I sat around a large table or desk, all seated at the same level. The settings varied with regard to comfort and level of distraction. The furniture was not always comfortable, such as when only stools

or pre-schoolers’ chairs were available in the room assigned. Distractions ranged from banging doors on a windy day, to children’s exuberant singing of Happy Birthday from adjacent classrooms, to the school bell ringing three times very loudly right above our head in a hallway. Nonetheless, the children were able to quickly refocus and immerse

themselves in the session.

3.2.4.4 Research Tool

A semi-structured interview guide was developed for the focus group sessions, listing a number of primary themes and questions essential to cover, as well as probes which could be followed up depending on time constraints or previous discussion. (See Appendix 3.9).

Once again I adhered to recommendations regarding flexibility, where the guide establishes the agenda for the discussion, but does not constrain it (Wood Charlesworth & Rodwell, 1997). Following Glesne and Peshkin (1992), I used a questioning style which was structured (having specific questions which needed to be asked), open (where I was prepared to follow leads), and depth-probing (where I expressed keenness to learn more).

Research with US pre-school children had also highlighted the usefulness of a game approach to gleaning how children conceptualised food and nutrition (Plum et al., 1998).

Consequently, for my focus groups I used a selection of props, including real foods and beverages and two sets of good quality colour photographs. Photos have often been used in interviews with children, such as to identify their food preferences (Guthrie, Rapoport &

Wardle, 2000), their perceptions of vegetables (Baxter, Schroder & Bower, 1999), their choice of food for breakfast (Jonsson, Gummeson & Svensson, 1998), their organisation of meals for three days (Gutzeit, Bloth & Hagenow, 1995) and their classification of ‘healthy’

and ‘unhealthy’ foods (Calfas, Sallis & Nader, 1991). Researchers have claimed that, through use of photographs co-operation was more assured, and that photographs were more reliable than food models, but less reliable than the real food. The main themes in my focus group guide and corresponding props utilised can be seen in Table 44.

I followed the interview guide fairly rigorously for the first two focus group sessions.

However, as the sessions progressed the interview guide was revised a number of times as a result of the answers given by the children. Known as progressive focusing, these

modifications allowed me to explore different issues which were emerging from the

conversations. In total, five different versions of the guide were developed over the span of the 16 sessions. In some instances probes were added to explore previously ignored aspects of a theme which emerged from the children’s answers (e.g. within the theme of

TABLE 44

Main Themes and Complementary Props Used For the Children’s Focus Groups

Theme Prop

Health value of food Three different lunch boxes with real food:

Lunch box A = White roll with salami, cereal bar, orange juice Lunch box B = White bread sandwich with Nutella, packet of salted snacks, orange squash

Lunch Box C = Wholemeal sandwich with ham, lettuce, tomato, banana, water

Consumption of fruit No props Consumption of vegetables No props Consumption of milk: including

foods: focus on traditional foods and environmental factors including the mass media

Photos:

Savoury snacks = hobz biz-zejt, bread with Nutella, hot dog Sweet snacks = Qaghaq/biskuttelli, Kinder Delice, chocolate chip cookies

Peer influence and prestige value of foods

Real food comprised of a selection of the following: bread roll with sliced cheese, white sandwich with Philadelphia cheese and tomato, apple, small container with fresh fruit salad, apple, packet of salty snacks, popcorn, Ribena, Breakers fruit drink^a a Additional items were included in the final sessions such as a baguette, cherries, dried raisins and apricots in a small container, apple chips, muesli bar, mini-pack of Weetos cereal, ice tea, ‘light’ juice

‘healthy food’ asking about their understanding of the term ‘diet food’), whilst in other

versions different props were used in order to generate more specific data about a particular question (e.g. adding apple chips and dried fruit to explore the value of novelty in creating a special packed lunch). Sometimes certain questions were omitted as it became clear that the children were repeating answers from previous lines of enquiry, or else I decided that the questions were not reaching their objective.

Various strategies were used in order to try to explore the prestige value of foods, however, this proved to be a difficult concept to tackle with the children whilst ensuring a reasonable degree of validity. For example, questions were asked in relation to creating a lunch box for themselves which classmates would also wish they had, listing the contents of a ‘gift’ lunch box which they knew would be desired by all their friends, preparing a ‘special’ packed lunch as a gift for a new friend at the beginning of the scholastic year, or preparing a ‘special’

packed lunch for their best friend. By the end of the sixteen sessions it was clear that the concept of prestige as perceived by myself was beyond the perceptions of the children being studied.

3.2.4.5 Data Collection Procedure

In preparing for and during the actual sessions, I kept in mind recommendations for

successful interviews as described by Glesne & Peshkin (1992). These included anticipating what materials and equipment were required and using them strategically, being alert to establishing rapport with the participants, assuming a certain naivety by which assumptions and pretensions are set aside, being reactive and directive and establishing a non-threatening, warm and caring atmosphere. At the same time, I sensitised myself to the fact that the analytical process was ongoing, so that even during the actual sessions I would need to consider relationships, salience, meanings and explanations which could lead to new questions.

An audio test was held at the beginning of each session to ensure quality of recording and to introduce the tape recorder to the children. The children were very mature and though some of them giggled or teased each other when they heard themselves speak during playback, they very quickly settled down when I told them it was time to start. I also laid some ground rules, such as reminding children that they should let each other finish before starting to speak and to avoid speaking at once. These rules were somewhat difficult to maintain during a few of the interviews (sometimes minor reprimanding was necessary), but in general children co-operated and the tape recordings were nearly all clear enough to be transcribed in their entirety.

Overall, the children seemed to enjoy the sessions. The interview progressed from use of realia as prompts, to talking without visual aids, then to the use of photographs as prompts and finally finishing with realia again, where this time children had to physically sort foods to create a packed lunch. This sequence kept the children constantly involved and intrigued.

Visual aids were removed when not in use and only taken out again when required. This helped to avoid any distractions and kept the children focused on the topic being discussed.

If children indicated they were uncomfortable in their chairs they were allowed to get up and move around, or even kneel on their chair. This only happened twice however. As in

previous data collection events, the one complaint by some of the children was that the sight of all the food was making them hungry.

At the end of the interview, children were given an envelope to take to their parents. This was an invitation and Consent Form asking for parent volunteers to participate in telephone interviews as a follow-up to the interviews with children. (See Appendix 3.10). The children

were asked to return the forms in the envelope provided to their class teacher. Heads of Schools were informed that the envelopes would be collected in two weeks time. Eventually, some Heads of Schools voluntarily mailed me the envelopes, once all six had been returned by the children.

3.2.4.5.1 Duration

The focus group interviews lasted between 65 and 90 minutes, with the average duration being 75 minutes. Glesne & Peshkin (1992) have stated that “qualitative researchers operate from the assumption that they cannot exhaust what there is to know about their topicUthat the better you probe, the longer the interview becomes” (p.85). Focus group interviews with children have normally been of around 20-45 minutes duration (Houghton, Durkin & Carroll, 1995; Wood Charlesworth & Rodwell, 1997; Connors, Bednar & Klammer, 2001). My focus group sessions were extremely lengthy in comparison. This situation developed as the children engaged themselves enthusiastically in the task, revealing personal perspectives, offering various examples and recounting anecdotes. Most times I felt obliged to listen to the children as much of the information being forwarded was extremely relevant. None of the children complained about the length of the interviews, but a few did ask to be excused to go to the bathroom for a few minutes, or asked to return to their class quickly to have a drink. In the exceptional case where two girls did ask to leave, I immediately granted them permission to do so. (It seems the girls had been working on a computer before the session began, and this was a ‘treat’ as normally access to computers was limited). Similarly, when a

hyperactive boy was part of the group, at one point he seemed to become very fidgety and so I actually asked him (unthreateningly) if he wished to leave. The boy accepted and the facilitator was called in to take care of the child.

3.2.4.6 Data Recording And Analysis

As already indicated, all the focus group interviews were audio-recorded using a micro tape recorder with an in-built microphone. After each session I transferred the tape recordings to regular audio cassette tapes, thus preserving the data in another format. In addition, on the same evening that a focus group was conducted, I would write down notes and reflections on the session. These described characteristics of the group members, the setting for the focus group and any procedural issues. They also highlighted any salient comments made by the children, evaluated any adaptations made in the research tool and suggested recommendations for future action. Thus, a day-by-day record of the key outcomes and progress of the focus group interviews was produced, contributing to confirmability of the

data. This procedure was in keeping with the anticipatory attribute of a good interviewer as described by Glesne and Peshkin (1992), where the daily task of log-writing prepares the researcher for what is next, both broadly in terms of the inquiry, but also narrowly in terms of the next day’s activities.

The sixteen tape-recordings were transcribed verbatim, producing a total of 373

The sixteen tape-recordings were transcribed verbatim, producing a total of 373