Both focus groups and in-depth qualitative interviews were conducted with adults who self-identified as Latino, and as a parent or primary caregiver to a child aged 1–5 years. Focus\groups are a particularly effective method for developing a deeper understanding of the reasons behind poorly-understood beliefs or behaviors, such as tap water avoidance [20 , 21 ]. Moreover, their interactive group format encourages a more relaxed discussion among marginalized populations such as farmworkers or recent immigrants who may feel less comfortable expressing their views on sensitive topics, such as their beliefs about water contamination, to outside researchers. In-depth qualitative interviews with key informants (e.g., water vendors, store managers, civic leaders, local dentists, WIC officials), and community participants (a few of whom might also have participated in the focus groups) explored in further depth those topics which emerged as important during the focus group sessions. Brief focused ethnographic observations provided a broader understanding of the context of water purchase and consumption behaviors.
Each focus group session or interview lasted between 1½ and 2 hours. Participants received a $20 gift certificate upon completion of this activity. Interviewers were bilingual local residents who were trained for and experienced at conducting both survey and interview-based health research. Each session or interview was audio-taped, translated from Spanish and professionally transcribed by a native Spanish speaker. Transcription was checked by study staff who back-translated, and compared the audiotapes to the translated and transcribed text, noting any difficult to translate segments. The semi-structured interviews comprised open-ended questions followed by probes, with topic areas and questions derived from the literature and prior work. Major questions focused on beliefs about the quality of the tap water and other local water sources, including beliefs about water safety, and water consumption practices, including water use for drinking, infant formula mixture, and cooking. Other questions explored beverage preferences and consumption; knowledge of and beliefs regarding fluoride including acceptability of water-based fluoride delivery mechanisms such as fluoride drops/tablets, fluoridation of filtered water stations, or fluoridated bottled water purchased at additional expense. Participants also completed a brief questionnaire about socio-demographic characteristics, evaluation of overall health and oral health status for themselves and their children, and water consumption practices.
Analysis of how participants gave meaning to their experiences, developed water-related beliefs, and how cultural context and local environment shaped water-related practices was guided by a broadly social constructivist theoretical approach that underpinned this study. This approach relies on data collection and constant comparison of themes presented by participants to develop a conceptual model of participants’ ideas as these emerge directly from the observational and text data [22 , 23 ]. This qualitative approach has been successfully used to explain other empirical including health-related phenomena that are otherwise poorly-understood. It yields a rich understanding of tap water avoidance/bottled water use that complements quantitative descriptive accounts. Two researchers independently applied codes that were developed, from the existing literature and from themes emerging from the transcripts. Codes were iteratively applied to the text using, when appropriate, a qualitative software program (NVivo® 7.0) to assist with the tracking, storage and retrieval of coded text. In addition, when reviewing the text, the ways participants responded to questions were enumerated (e.g., knowledge about fluoride). Where appropriate, descriptive statistics were generated using SPSS to provide a more detailed profile of participants and their water usage, a profile that complements and expands the thematic analysis. Illustrative quotations, typical comments made by respondents, are included in supplemental material accompanying the online article.
Each focus group session or interview lasted between 1½ and 2 hours. Participants received a $20 gift certificate upon completion of this activity. Interviewers were bilingual local residents who were trained for and experienced at conducting both survey and interview-based health research. Each session or interview was audio-taped, translated from Spanish and professionally transcribed by a native Spanish speaker. Transcription was checked by study staff who back-translated, and compared the audiotapes to the translated and transcribed text, noting any difficult to translate segments. The semi-structured interviews comprised open-ended questions followed by probes, with topic areas and questions derived from the literature and prior work. Major questions focused on beliefs about the quality of the tap water and other local water sources, including beliefs about water safety, and water consumption practices, including water use for drinking, infant formula mixture, and cooking. Other questions explored beverage preferences and consumption; knowledge of and beliefs regarding fluoride including acceptability of water-based fluoride delivery mechanisms such as fluoride drops/tablets, fluoridation of filtered water stations, or fluoridated bottled water purchased at additional expense. Participants also completed a brief questionnaire about socio-demographic characteristics, evaluation of overall health and oral health status for themselves and their children, and water consumption practices.
Analysis of how participants gave meaning to their experiences, developed water-related beliefs, and how cultural context and local environment shaped water-related practices was guided by a broadly social constructivist theoretical approach that underpinned this study. This approach relies on data collection and constant comparison of themes presented by participants to develop a conceptual model of participants’ ideas as these emerge directly from the observational and text data [22 , 23 ]. This qualitative approach has been successfully used to explain other empirical including health-related phenomena that are otherwise poorly-understood. It yields a rich understanding of tap water avoidance/bottled water use that complements quantitative descriptive accounts. Two researchers independently applied codes that were developed, from the existing literature and from themes emerging from the transcripts. Codes were iteratively applied to the text using, when appropriate, a qualitative software program (NVivo® 7.0) to assist with the tracking, storage and retrieval of coded text. In addition, when reviewing the text, the ways participants responded to questions were enumerated (e.g., knowledge about fluoride). Where appropriate, descriptive statistics were generated using SPSS to provide a more detailed profile of participants and their water usage, a profile that complements and expands the thematic analysis. Illustrative quotations, typical comments made by respondents, are included in supplemental material accompanying the online article.
