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Note: We would like to keep track of who uses this toolkit in the future. If you choose to use it, please email Pamela Gould at pgould@jeffco.us.
Communities that Care (CTC) at Jefferson County Public Health (JCPH) hired 21 youth researchers to better understand youth perspectives on what underlies youth depression and anxiety, youth violence, and youth substance abuse. Seven three-person teams of youth researchers from four schools conducted focus groups and completed photovoice projects about these topics. The schools represented were Jefferson Junior-Senior High School, Lakewood High School, Long View High School, and Wheat Ridge High School.
The 21 youth researchers conducted six focus groups and participated in two focus groups for a total of eight youth focus groups. Seven photovoice projects were produced: four videos and three posters. The photovoice topics included sexual violence, youth emotional distress, and youth substance misuse.
The focus group results and the final photovoice products were presented on April 27, 2018, at a community event called the Recognition & Discoveries Reception. The focus group findings were displayed on posters. The photovoice videos were screened twice during the two-hour event, and the photovoice posters were displayed throughout the entire event.
The following sections describe the processes and provide the resources used during this project for the initial youth engagement and recruitment, completing the focus groups and photovoice projects, and data analysis.
Three strategies were used to recruit youth:
A Youth Advocacy Workshop (YAW) was held at Jefferson County Administration to teach youth leadership skills and how to be an advocate for health in their communities. At the YAW, attendees were informed of the internship and how to apply for it.
An informational flier was shared with high schools in the target zip codes. School staff were encouraged to hang up these fliers as well as tell students about the internship directly. This flier is shown to the right.
CTC board members were encouraged to share information about the internship with youth that they know.
Youth were invited to apply in teams of three. All team members had to be from the same school and applied together on one application through Google forms. The application was available for about one month. The application questions are shown to the right.
After completing the applications, each team was invited for an interview. Each team was interviewed, as a group, by members of the CTC coalition. Interviews lasted approximately 15 minutes, after which the interview team provided comments and a score to staff members. Staff then interviewed the students about their ability to attend meetings and complete the project, along with finding out if the wanted to use their own computer or borrow one and if they needed assistance with transportation.
Each newly-hired youth intern was given a packet of forms to sign – or have a parent/guardian sign if they were under 18 – and return to CTC staff at the first meeting. The forms included:
Confidentiality statement
Media consent form
W-9
Letter of agreement
Consent to participate form for those under 18
All forms except for the letter of agreement are standard JCPH forms. Youth also received a schedule describing how the eight weeks were set up.
The interview questions, and the eight-week schedule are shown to the right.
The youth were paid at the end of the internship for successfully completing three components as outlined in a signed letter of agreement:
Attend at least 7 of the 8 meetings, arriving within 10 minutes of the start time and leaving no more than 10 minutes early.
Plan and conduct a focus group with at least 6 other youth participants from their school.
Complete a photovoice project that included at least 20 photos and/or video clips from 10 or more different places. The final product could be either a three-to-five-minute video or a poster.
Each youth researcher earned up to $325. Youth researchers earned $125 for attending at least 7 meetings, $100 for holding a successful focus group, and $100 for completing a photovoice project.
As part of the signed agreement, each youth researcher agreed to:
Participate in a focus group, and
Work with the other members of their three-person team to host a focus group consisting of no fewer than six other students from their school.
A focus group guide, including a detailed script and focus group questions, was created by CTC staff at JCPH with technical assistance from CTC staff at the University of Colorado Boulder (CU Boulder) and input from the CTC Data Work Group. During development, the group engaged in online editing of potential questions using a Google Doc.
The focus group questions were designed to accomplish these goals:
Promote discussions about both risk and protective for the youth issues of substance misuse, violence, and mental health; and
Understand a wide range of influences on youth including personal traits, relationships with families and friends, the school environment, and the broader community.
Before conducting their own focus groups, the youth researchers participated in two focus groups led by CTC staff. This allowed them to understand their roles in running a focus group. In addition, their responses to the questions were included in the data analysis.
In conducting their own focus groups, each youth research team member had a unique role. One person was the facilitator, one person was the co-facilitator, and one person was the note-taker. Teams that did not have their own computer to take notes borrowed one from JCPH. In each focus group, two or three CTC staff were present to assist with taking notes and support the facilitator and co-facilitator as needed.
Each youth researcher and staff member had a copy of the focus group guide during the focus groups. In addition, two or more copies of a second version of the guide was available with the questions written in large print on a flip chart so that youth participants could see them during the discussion. Each question was written on a separate page. Youth and CTC staff turned the pages at the beginning of each question. The traditional and large versions of the guide are shown to the right.
Each focus group discussion was recorded using two Yemenren 8GB voice recorders. To protect the youths' privacy, the recordings were deleted after they were used to fill in the notes taken at each focus group.
Youth who took part in the focus groups also filled out a two-page demographic survey. The first seven questions in the survey were from the 2017 Healthy Kids Colorado Survey (HKCS). The other questions asked youth about their zip code and city of residence. This survey is shown to the right.
Because the topics discussed in the focus groups were sensitive and had the potential to upset youth, all the youth focus group participants received a one-page handout with a list of resources to utilize if they needed help or support outside of the focus group discussion. This resource list is shown to the right. Additionally, therapy dogs were available to students following some of the focus groups.
Participants were told that staff members in the room are mandatory reporters and staff explained what mandatory reporting means. Participants were encouraged to talk in generalities or use non-identifying phrases like "someone I know."
Analyzing the focus group data was a seven-step process, guided through technical assistance provided by the University of Colorado Boulder Technical Assistance team provided by the Colorado CTC initative. The data analysis team included two CTC staff, two graduate students, and one CTC Data Workgroup member, each of whom attended a training led by Dr. Erin Wright from University of Colorado Boulder.
The process used was as follows:
Create a codebook. CTC staff at JCPH made a codebook with technical assistance from CTC staff at CU Boulder and input from the CTC Data Workgroup. Each comment made by the youth was assigned a code, or topic, that described the idea of what was being said.
Print out the notes. The notes from each focus group were printed on different color paper to identify which comments came from which group. This was important later, in step seven, when each comment was cut out. The notes were printed one-sided and with space between each comment to make it possible to cut out individual comments.
Standardize the coding process. To standardize the coding process, one focus group was analyzed by the entire group. Afterward, a second focus group was analyzed by each person individually. After each person completed it, the group came together to compare their analyses and resolve discrepancies.
4. Finish coding. The other six focus groups were each coded by two people. When pairs disagreed on any code, they would discuss it before making a final decision.
The coded focus group notes are shown to the right.
5. Create master copies of the coded notes. A master copy of each focus group was created with the agreed-upon codes after all the focus groups were coded. Two copies of each master copy were made on white paper to keep a printed record of the notes.
6. Cutting up the notes. Next, the data analysis team used scissors to cut out each individual comment. The comments were sorted so that all the comments for each code were placed in a separate pile. The data analysis team wrote down the number of times that each code was use before analyzing the data further.
The sorted, cut-up focus group comments are shown to the right.
7. Looking for broader themes. After the comments were sorted, the team looked at relationships between different codes to identify broader themes that came up across all or some of the focus groups. The team used a sticky wall to arrange all of the comments into these broader themes. The different colors of the paper made it easy to see which ideas were mentioned by most or all of the groups, and which ideas were mentioned by only one or a few of them.
Two members of the data analysis team organizing comments into broader themes on the sticky wall are shown to the right.
The demographic survey was used to understand who participated in the focus groups and whether there was diversity among the youth. The research team used descriptive statistics to understand the variation in age, grade in school, race and ethnicity, gender, sexual orientation, and where youth live.
As part of the signed agreement, youth researchers created a photovoice project related to one topic from the focus group discussions. At minimum, each team was required to take 20 original photographs or video clips from at least 10 locations in Jefferson County. Youth were provided with a “tip sheet” about taking high quality photos or videos, which is shown to the right.
Researchers used their own smartphones or cameras to take photographs. They were asked to upload them to a shared Google folder, but in most cases emailed them to a staff member or put them directly into their template, which is shown below.
The youth used the SHOWED method to organize their projects. SHOWED stands for:
What do you SEE here?
What is really HAPPENING here?
How does this relate to OUR lives?
WHY does this problem or situation EXIST?
What can we DO about the problem or situation?
CTC staff created a Google Slides template for each team to use for their photovoice project before they made their final products. This template is shown to the right.
One of the seven groups produced a video.
Three groups created a voice recording and PowerPoint, which staff meshed to create a video.
For three groups, staff glued the group's Google Slides to a tri-fold poster for presentation.
All photovoice projects were reviewed by CTC staff prior to their public presentation.
Researchers presented their focus group data and photography products at an event for the Jefferson County Communities That Cares Board and Key Leaders.
Videos and photographs were not posted online.
Posters were created by staff members with quotes from youth, organized by topic. A summary of findings, displayed at right, was also passed out at the event and is being used for planning next steps.
Note: We would like to keep track of who uses this toolkit in the future. If you choose to use it, please email Pamela Gould at pgould@jeffco.us.