Voices of food insecurity: Exploring barriers and strategies to healthy food access

This is a draft protocol for our participatory data analysis workshops. We would love feedback on our ideas and hope that these details will be helpful for others to think about doing participatory data analysis.

We will host a series of participatory data analysis workshops with two separate cohorts of people affected by food insecurity in the Boulder community. The participants in each cohorts will be a single group that is consistent across the series of workshops. One series will be done in English and the other series will be done in Spanish. The protocol for the workshop series will be covered over the course of 2 - 4 workshops that will each build off of the previous. Each individual workshop session will last between 1.5 and 2 hours. The total number of workshops (whether it is 2, 3, or 4) will be driven by the participants as to whether they feel that we have finished with analyzing the data and resolved all the issues that have surfaced through the analysis activities.

Midway through each workshop session, we will ask the group whether they think they would want to meet again to continue discussing and exploring the data. If so, we will schedule the next meeting at the end of the workshop. If they do not think we need to meet again, then we will adjust our time allotment for the activities to ensure that the group can reach all of the steps in the protocol. In the case that some members are unable to attend a subsequent meeting, due to availability, but would still like to participate, we will offer to meet them individually and conduct similar research activities.

Activities prior to the first meeting

To prepare for the first data analysis workshop, we will review the transcripts from the first study, the Multimedia Interviews, and select a random sample of them from individuals that are not participating in the data analysis workshop. Participants from the interview study will also be invited to participate in the participatory data analysis. We feel it is important to exclude interview data from those individuals who participate in the workshop to minimize the potential for discomfort in having their data analyzed in their presence and to reduce the risk that someone in the group may make a negative statement about what they said.

We will print out the randomly selected sample of transcripts in large font and cut out excerpts of text from those transcripts that we identify as relating to a single topic. These excerpts will be full or partial sentences or longer stories that were spoken by interview participants during their recorded interviews. For each excerpt, members of the research team will identify if the excerpt needs to be de-identified, and if so, make edits to the excerpt and reprint it to be included. If it is deemed not possible to de-identify an excerpt, we will remove it and replace it with another. We envision needing 35 excerpts per participant in the workshop, given the time available for the workshop. Therefore, we will randomly select excerpts and place them into different containers, one for each person who has signed up to attend the workshop, until there are 35 excerpts for each workshop participant.

Informed consent for participation

We will ensure that participants have a detailed understanding of the research project before attending the workshop - either by meeting with them in person or discussing it over the phone. For those that we meet with in person, either at a food bank, their home, or another private location that they identify as convenient we will gain informed consent if time permits during that meeting. For those that we do not meet in person or who are unable to provide informed consent prior to the workshop, we will ask them to come to the workshop at least 15 early to review the consent form and provide informed consent if they decide to participate. Those who do not wish to participate at that time will be able to leave before the beginning of the workshop. We will also emphasize that anyone can leave at any point in the workshop for any reason.

Introductions and brief training

The first activity will be introductions of everyone present including research team members, participants, and a translator if one is present. Everyone will be asked to only use their first names during the workshop activities and will also be provided a name tag onto which they can write their first name. We will use one or more icebreaker activities for the group to get people talking and comfortable sharing with the group. It's important that the activities that we choose focus on helping people get to know each other, get comfortable speaking to the group, get comfortable asking questions of their peers, and get them thinking about food. We want to avoid questions that might expose sensitive topics for people or make them feel like they are outsiders from the group. For example, we would not want to ask everyone to share what they do for a living since some participants might be jobless. The icebreaker activities may include:

1. Ice breaker questions that provide participants an opportunity to share something relatively benign about themselves that is related to food, such as, “What food could you not live without?,” “What is your favorite fruit or vegetable?”, “What was the most positive experience you can remember having around food?”

2. Eliciting participant’s preconceived notions and beliefs about food insecurity by asking them to describe either 1) a barrier they think people have getting food in Boulder or 2) a tool that they think people use to help them get food.

3. An interview activity, where participants will pair up and introduce themselves to each other and ask each other a couple questions such as their name, their favorite food, how long they have lived in Boulder, and their favorite animal. After conducting the interview, they will then introduce their partner to the rest of the group.

Following the introductions, we will briefly discuss a shared set of ground rules with participants that includes not disclosing any specific information or experiences shared during the activities without first discussing it and gaining agreement of the group, respect others when they are talking, refrain from personal attacks, participate to the fullest of your ability, speak from your own experiences when possible, and any other ground rules that participants would like to establish. We will then elicit ground rules from the group and add them to the list of rules. With respect to sharing information outside the group, we will instruct the group that during the last meeting we will spend time figuring out what and how we want to share information, so we need to wait until that discussion before we share outside of the ground.

After the group establishes ground rules, the research team will provide a brief introduction to the research project and the interview study, which is the basis of the data set that they will be analyzing. Following that, we will provide a brief presentation on the topic of qualitative data analysis and thematic analysis using coding. This will focus on establishing the goals of the activities - creating a general understanding of the common themes that occur across individuals and identifying the unique experiences that are not common across individuals. This is intended connect the analysis activities with the broader goals of research.

We will also include at least one example to demonstrate how to code excerpts of data and relate multiple excerpts to each other. Specifically, we will conduct two demonstrates. In the first demonstration we will use a playful example about coding and developing themes for cooking instructions (recipes). In the second demonstration, we will use example data from the interview study. For both activities, we will convey how to take a handful of excerpts and identify two of those that are similar in someway and describing that similarity as a thematic code. We will use the guiding questions in List 1 to help people develop labels for excerpts and determine whether and how excerpts are similar.

List 1. Prompts for developing category labels

1. How would you summarize what these individuals are saying in a few words?

2. What do you think is going on in these statements?

3. What do you think is similar between these statements?

Following the brief training, we will put participants into dyads by pairing them with the person sitting next to them. In the case where we have an odd number of participants, we will create a group of three. We will ask people to work with their partner to try out the activity for one pair of excerpts. They will be asked to select 5 excerpts from each of their baskets and then, as a dyad, identify two excerpts that are similar based on the content or underlying meaning. They will then be asked to name, or provide a label to, the similarity between the two excerpts. Researchers will roam around the group during this time to help clarify their questions and ensure that everyone understands the activity.

Once all the dyads have identified their pair of excerpts and assigned them a title, each dyad will report out to the group on the two excerpts they identified and the title they generated. They will place their excerpts on a whiteboard or piece of butcher paper using tape and then write the descriptor on a sticky note to put next to it. Questions, uncertainties, or disagreements will be discussed as a group and feedback will be provided.

During the share out, we will look for any commonalities across the themes that the dyads identified and then use that to explain how pairs of excerpts can be combined or grown with additional excerpts that relate to the same idea. If no commonalities exist, the research team will identify an excerpt to add to one of the themes to show how the groupings can be grown and iterated on over time as more excerpts are reviewed. After the share out is complete, we will answer any questions that the activity provoked from participants.

Grouping similar excerpts with labels

When no questions remain from participants, we will ask them to use the guiding questions we provided (see List 1) to work with their partner to process the rest of their excerpts in the same manner we had demonstrated. The goal will be to identify pairs of similar excerpts, provide labels for those excerpts, and then combine groups of excerpts sharing similar themes into larger groupings. Each dyad will be given a piece of white butcher paper to tape their groupings of excerpts along with the labels for them. This will allow them to move the data around and dynamically change their groupings and labels as new data emerges or as their understanding of the themes evolves. Members of the research team will float around to the different dyads and help them work through challenges and provide support. Participants will continue until they have grouped all of their excerpts or until they are left only with excerpts that do not belong with any group. Participants will keep any excerpts that do not belong with others groups in their own singleton groups.

Merge and organize themes across dyads

Once each dyad has completed grouping and labeling their excerpts, we will reconvene the whole group and let each dyad share out their findings. All of the pieces of butcher paper from the dyads will be placed next to each other along the wall and the dyads will take turns presenting their findings to the group. As dyads share their findings, the others will be instructed to listen carefully to the themes and use the prompts in List 2 to identify themes from their own analysis that might be related or might overlap in some way.

When a dyad identifies a similar theme, we will ask them to briefly describe their theme and the entire group will decide, using consensus decision making, whether the themes should be combined or whether another relationship should be described between the two themes. Examples of different relationships include cause/effect, temporal, and thematic antonym. For participants, we will describe them in more approachable ways such as two themes where one is a cause and the other would be its effect, themes related by time (before, after, at the same time, etc), and themes that are opposites of each other. We will ask participants to provide evidence or examples from the data that support their claims regarding the relationships.

List 2. Prompts for merging and organizing themes

1. What are two themes that you see that you think are related? How are they related?

2. What do you think caused or led to the situations represented in this theme?

3. Do you think that any of the situations in one theme were caused or affected by the situations from another theme?

4. Are there any statements or data that you think refute this point?

After all the dyads have shared, we will ask everyone to look for one more pair of common or related themes across all of the papers. Individuals will get up and move to the pieces of butcher paper along the wall to review the themes closer and try to identify two themes that are related. They will then present the new grouping or relationship that they have identified to the rest of the group for discussion and consensus decision making. In cases where an agreement cannot be reached about the relationship between two themes, we will keep the themes separate and document the potential relationships that the group described.

Individual responses to the findings

Once the grouping and relating of themes has been completed, we will ask participants to reflect on their own experiences in relation to the findings. We will ask four questions to guide their reflection which include:

1. What was one thing that a person said that surprised you the most? What surprised you about it?

2. What is a theme that you would want to explore further or know more about?

3. Are there any experiences that you have had or heard from others that run counter these themes?

4. Have you had or heard of any experiences that are similar to these themes?

After everyone has had a chance to write down responses to each of these questions, we will provide a space for people to share out their thoughts. People can decide whether or not they want to share and there will be no expectation that they do so at this point - allowing people to keep their own personal experiences private if they choose. Members of the research team will also be able to share their experiences and reactions to the data as well. We will ask people to provide evidence from the data or specific examples from their experiences to support their responses to these different questions.

Discussing dissemination

The final step with the group will be to develop a dissemination plan for the findings. We will use a think-pair-share approach where we will again assign participants into dyads. They will be asked to develop responses to a series of prompts (see List 3), presented one at a time, by first discussing with their partner and then sharing out their ideas to the larger group. Members of the research team will also share their ideas during this time.

Before participants begin the think-pair-share activity, we will outline any dissemination activities that we will not be able to support due to ethical considerations. For example, we would not be able to share the identities of anyone in the group or of anyone that participated in the interview study, unless they revealed their identity of their own volition. We will also caution participants that activities that might have a cost associated with them may be difficult for us unless we were to receive additional funding or assistance. The goal of informing them of these ethical and financial constraints is to help them understand why we may not be able to act upon their ideas, even if they are great ideas. We would not want people to mistakenly think that we simply ignored their idea because we didn’t like it or because we didn’t want to do it.

List 3. Prompts for dissemination discussion

1. Who do you think should know about the information we discovered today?

2. Name one person you know personally who you will share what you learned from the workshop?

3. (In what form/how) do you think we could share the findings we developed to help people better understand the challenges in getting food in Boulder? For example, an online blog, social media, or educational handouts.

4. Where would you want to see these findings displayed?

During the share out, one participant will be in charge of writing down the ideas on a whiteboard or piece of butcher paper to preserve them. Once we have written out all of our ideas, we will go through each idea and ask the group, including members of the research team, to use their thumbs to indicate their level of interest and comfort with each idea. A thumbs up means they are very interested in the approach, a sideways thumb means they are not very interested or uncertain, and a thumbs down means they are uncomfortable with the idea. We will inform the group that if there are any ideas that they are concerned about, but don’t feel comfortable sharing during this activity, then they can speak with us afterwards. We will let the group know that this voting will be the prioritization of our efforts to share the findings. One participant will be in charge of tallying the thumbs up and noting any thumbs down next to each idea.

We will briefly review the results of that activity, especially those receiving a thumbs down to understand the concerns people have. If there is still a concern after discussing an idea and we cannot come to an agreement, those that still have at least one thumbs down will be excluded to ensure people feel comfortable with the overall plan.

The very last activity will be a quick check-in with every participant to ask them to identify one thing they learned from the activities and if there are any ways use they will use that information in their life. During this time, we will also ask participants who would like to be involved with disseminating the results to write down their first name, best contact information (either phone or email), and the types of activities they would like to be involved in based on the dissemination ideas we developed. We will collect the papers from those that want to be involved in some way and let them know that we’ll follow-up based on their interests.

The research team will make themselves available after the workshop comes to a close to answer any of the participant’s questions, to talk through next steps for people that want to maintain involvement going forward, and to address any concerns.

Providing a thank you for participating

Because we are asking for a significant commitment from folks, we plan to provide gift cards to local grocery stores or healthy eating venues to express our gratitude for their help. Each individual will receive $45 in gift cards, which will be distributed as $20 during the first meeting and $25 at the second meeting. For those who cannot attend the last meeting, we will coordinate a time to meet with them individually to conduct data analysis activities, discuss the findings, gain their feedback on dissemination, and provide them with their gift cards.

References

This protocol has been inspired and informed by Jackson (2008) and Fortin et al. (2014).

Jackson, S. F. (2008). A participatory group process to analyze qualitative data. Progress in Community Health Partnerships : Research, Education, and Action, 2(2), 161–70.

Fortin, R., Jackson, S. F., Maher, J., & Moravac, C. (2014). I WAS HERE: young mothers who have experienced homelessness use Photovoice and participatory qualitative analysis to demonstrate strengths and assets. Global Health Promotion, 0(0), 1–13.