DATA COLLECTION

Focus group methodology was used to explore the shared group experience and perceptions of late night eating. The moderator was trained and experienced in multiple qualitative data collection methods including focus groups, nominal group technique, and motivational interviewing. The a priori plan was to conduct 3–4 focus groups, comprising of 6–8 participants per group, which has been suggested as adequate to achieve saturation.²⁰ The moderator used a semi-structured interview script to help guide the focus groups (Table 1). One researcher (PCL) who had experience with metabolic health during pregnancy in the black community, developed the interview script using guidelines from Krueger and Casey.²⁰ Two different researchers (MB and TC), who were familiar with the patient population at the clinic and had prior experience with qualitative research,^21,22 reviewed the interview script for clarity and appropriateness. The questions posed in the script prompted conversation about participants‟ perceptions of individual and interpersonal factors that contributed to late night eating, specific food and beverage choices, barriers to changing this behavior, and perceptions of a proposed intervention to modify late night food and beverage choices. Sessions were audio-recorded and a note taker was present. To facilitate familiarity with the participants and to promote openness to share during the focus group session, both the moderator and note-taker were selected to be racially concordant with participants.²⁰ The moderator reviewed the study procedures and the consent form at the beginning of each session, and informed consent was obtained from each participant.

Questions from the semi-structured interview used during focus group sessions.

As part of the focus group sessions, a buffet of foods and beverages was offered at a table within the room and women were encouraged to consume as much or as little as they wanted before, during, and after the session. The choices provided had a lower GI than had previously been reported as consumed by women in this clinic population.⁷ For example, diet soda was provided instead of regular, slices of cheese and salami were offered with no bread or pizza-type base, and fruit and vegetables were offered with low-sugar yogurt, ranch, and peanut butter dips. Towards the end of the focus group session, the moderator solicited feedback from the participants about their acceptance and liking of the food and beverages offered. The goal was to identify potential lower-GI food/beverages that could replace those typically consumed at night. Foods/beverages offered at the next focus group were revised after participant feedback. If an item was not discussed by the women or had positive feedback, it was offered during the next focus group to obtain continued feedback. If a food/beverage item had negative feedback, a Registered Dietitian identified an alternative to be offered at the next focus group. For example, diet soda was the lower-GI alternative to regular soda provided but received negative comments during the first focus group and so sparkling water was added for subsequent groups.

At the end of the focus groups, participants completed the Hollingshead Four Factor Index of Social Status,²³ along with two additional questions regarding the number of adults and children living in their household. Following each focus group, the moderator and note taker met to de-brief and discuss questions included in the interview script. Given that participants did not bring up topics that were not addressed in the interview script, no further changes were made to the script.

Focus group sessions were conducted until data saturation was reached.²⁴ Notes and transcripts were reviewed by the investigative team following the second session and it was determined that saturation had been met; however, a third focus group was held to confirm. No new themes emerged from the third focus group and thus data collection was concluded.²⁵ Childcare was provided in the clinic’s waiting area for children who accompanied women to the focus group. Monetary compensation for time and travel was provided at the end of the session. The university’s Institutional Review Board approved the study.