Focus Group Interview Guide

The objective of the focus group interview was to gain a clearer understanding of some of the food practices which were mentioned in the quantitative survey. A list of questions based on a cursory study of the survey responses was prepared to serve as a guide. (Appendix 3.6). Nonetheless, the interview itself was semi-structured and did not follow the guide in a rigid manner. The importance of focus group guide flexibility and an open-ended questioning style has been repeatedly emphasised (Glesne & Peshkin, 1992; Wood Charlesworth &

Rodwell, 1997). Eventually, less than half of the questions were covered due to time constraints and some interruptions. I preferred to exhaust and follow up on the issues mentioned by the children, rather than tackle the listed topics superficially.

3.2.2.6 Data Collection Procedure

The survey was conducted as a class activity and each session was led by myself with the assistance of the class teacher, or other substitute teacher present in the classroom at the time. Once the basic procedure was explained, the children were allowed to work on their own, but with constant monitoring. The children were stopped after completing the third setting on the first page and asked to indicate which one was their favourite from the different foods and/or drinks listed for each setting. One child’s sheet was used as an example. The children were given self adhesive multi-coloured stars to stick next to their preference. They were asked to stick a star even if they had only listed one food or drink item for a setting. Extra stars were given in case of mistakes and stray stars. This procedure of stopping after completing three settings to indicate preferences was followed for each sheet so that the children could be kept on track and assistance could be given where

necessary. The children were allowed to keep any remaining stars after the session was completed as a token of appreciation.

The focus group interview was held in the school library after library hours and one hour before school was over for the day. The first few minutes with the children were used to dispel the novelty of being audio-recorded and to lay ground rules for speaking. Once the interview commenced, all of the children participated enthusiastically; giving details about foods consumed, different brand names and when and how the foods were typically prepared. The willingness of the children to co-operate and the extensiveness of their answers confirmed my conclusions from Stage 1 of the research on the benefits of utilising focus groups with children.

3.2.2.7 Data Analysis

For the quantitative data, the children’s responses for each food and drink consumption setting were coded. All the different foods and drinks mentioned were listed and sorted into eighteen different groups as shown in Table 32. These groupings are similar to those in the National Cholesterol Education Program guidelines which have been used to classify data from dietary recalls conducted with children in the US (Dixon et al., 1997).

TABLE 32

Food And Drink Groups Used To Categorise The Coded Data

Breakfast Cereals Breads

Savoury Snacks and Pastries Pizzas

Pastas

Salads/Vegetables/Potatoes Soups

Cheese Eggs

Meat/Burgers/Sausages Rabbit/Chicken/Other Poultry Fish

Fast Food Fruit

Dairy/Fruit Desserts Sweet Snacks and Pastries Sweets

Beverages

In total, 671 unique foods, drinks or food and drink combinations were coded. Missing responses were assigned a 0. Nothing, Don’t know and Don’t go out responses were also given separate codes. The maximum ‘N’ possible in each setting was the number of respondents multiplied by 3 (3 referring to the maximum number of responses possible per setting).

Basic summary statistical tests were run to obtain percentage frequencies for each variable.

The main objectives were (i) to uncover the top six foods and/or drinks most commonly consumed in different settings and (ii) to pinpoint the three most favourite foods and/or drinks consumed in different settings. Since there was such a variety of food and drink items listed, percentage frequencies were also generated for (i) the top food/drink groups and, within these, the top food/drink items for each consumption setting; (ii) a number of food groups and specific food items which emerged as very popular; (iii) a number of specific food items which were much less commonly consumed.

The tape recording of the focus group interview was not transcribed verbatim as this particular interview was considered a trial of the method and the objective had been simply to elicit more detailed information in relation to what had been obtained from the freelisting exercise. I listened to the tape recording twice and key points which would help to give a more accurate picture of some of the children’s responses in the quantitative survey were noted. Any new insights were also extracted for possible follow-up in future stages of the research.

3.2.2.8 Results And Discussion

The various analyses run on the data provided a comprehensive picture of the foods and drinks children consumed in different settings and scenarios. A detailed report on the

findings and some initial interpretation can be seen in Appendix 3.7. This section will merely provide a snapshot of the major findings in order to show the link with the next stage of the research. The main purpose of the different analyses was to ensure that the foods chosen for response options in the subsequent quantitative stage of the research would truly reflect Maltese children’s eating habits, whilst serving to obtain data to meet the different research questions. The most common specific items consumed in each setting were identified. For example, the exact type of sandwich (bread and filling), the exact pasta dish (pasta type and sauce) and the exact pizza (specific ingredients) were uncovered. Similar analyses identified the most common items from each of the three cuisine orientations – Traditional Maltese,

Italian, Westernised - which were consumed in each setting, as well as less common items which could be indicative of waning or novel dietary practices.

3.2.2.8.1 Top Foods And Drinks Consumed In Different Settings

Key findings which emerged from the quantitative survey are presented in Table 33.

Overall, it was clear that certain foods and drinks were pervasive in Maltese children’s diets, emerging amongst the top six in several of the 12 consumption settings. These included pasta (5 settings), pizza (6 settings) and hobz biz-zejt (12 settings). Plain cheese and tomato pizza, pizza Margherita and pasta with tomato and garlic sauce, were the most commonly consumed pizzas and pasta dish. Such results were somewhat predictable and showed that certain food consumption patterns amongst Maltese children reflected international trends. In fact, in freelisting exercises conducted with children in the US to develop food frequency checklists (Gittelsohn et al, 2000; Smith et al, 2001) top items listed were beef (e.g. steaks, roasts), hamburgers, hot-dogs, fried chicken, chicken nuggets, chicken burgers, spaghetti or other pasta with meat and tomato sauce, lasagna, pizza, chips, apples, oranges, milk (white or chocolate) and ice-cream. These items were also commonly listed by Maltese children. In contrast, while very few of the American-Indian children in one of the above US studies listed traditional foods (Gittelsohn et al, 2000), Maltese children listed a number of traditional items, such as hobz biz-zejt, pastizzi and Kinnie. These traditional foods were perhaps a staple for some children, being consumed for Weekday Supper and School Packed Lunch;

yet they also seemed to have a treat value, often being consumed during a Sunday Drive or outings to the Capital city Valletta or the seaside. At the same time, there was a heavy orientation towards Westernised foods for both home-based and non-home based consumption settings, especially for less substantial meals and drinks. The various

influences on children’s perceptions and intake of traditional foods and other cuisine foods, including for example consumption setting, would warrant further study.

3.2.2.8.2 Top Three Favourite Foods And Drinks Consumed In Different Settings The children were also asked to select their favourite food from the ones they had listed for each setting. When one compares the results for the top favourite with the top consumed items, the first ranked is identical for each setting with only two exceptions. At face value, these results seemed to indicate that children’s preferences were a good predictor of consumption, but the mechanism of this process would need to be explored further. Some other noteworthy observations concerning top favourite and top consumed foods were that in

TABLE 33

Most Commonly Consumed Foods And Food Groups In Different Settings

• Cold cereals were consumed most frequently for Breakfast.

• Limiting the first meal of the day to either tea or milk was common.

• For conventionally ‘larger’ or more substantial meals (i.e. Weekday Supper, Saturday Lunch or Sunday Lunch) chicken (unspecified), pizza (unspecified, or plain tomato and cheese) and pasta (unspecified, or with tomato sauce or a sauce) predominated.

• Patata l-forn (baked meat and potatoes) and ‘meat and mashed potatoes’ were commonly consumed for Sunday Lunch.

• Fish dishes were commonly consumed for Weekday Supper and Saturday Lunch.

• Macaroni dishes were commonly consumed for Sunday Lunch.

• ‘Pasta with tomato and garlic sauce’ was the most commonly consumed dish for the After-School setting.

• The After-School setting was another mealtime for some children, whilst for others it was merely an opportunity to have a drink, or perhaps consume a light snack or sweet treat.

• Items in the pizza category were the most commonly consumed when Eating Out.

• Burger meals and chicken nuggets were commonly consumed during a Valletta Outing.

• Within the snack-type meal settings (Tea-time or When Hungry, Sunday Drive, Seaside Outing, Party), breads with different fillings or spreads, pastizzi, packet snacks, fruit (unspecified), banana and different beverages were the most commonly consumed.

• Packet snacks were the most commonly consumed item for Sunday Drive and Seaside Outing.

• Fruit was the most commonly consumed food group for Tea-time or When Hungry.

• Overall, the most common consumed bread items were variations of ham sandwiches or rolls and hobz biz-zejt.

• Overall, the most commonly consumed pizzas were pizza Margherita or pizza with tomato sauce, mozzarella and olives.

• Overall, the most commonly consumed soups were broth (unspecified), chicken broth, minestra (vegetable soup) and noodles in Bovril.

• Overall, pasta dishes were more commonly consumed than rice dishes.

• Coke and water were the two most commonly consumed beverages within the three different drink consumption scenarios

three settings (Weekday Supper, Sunday Lunch, Sunday Drive) traditional Maltese dishes and foods achieved higher placings as favourites than their placing as actually consumed.

Likewise, within the Party setting, pizza emerged much higher in the placings as favourite food than its ranking as consumed food, even surpassing cakes, sweets and Coke. Once again, these results were indicative of certain trends in children’s preferences, with a fondness for traditional Maltese foods and pizza. Further enquiry would be necessary to identify factors influencing these trends.

3.2.2.8.3 Insights On Food And Drink Consumption From The Focus Group Interview The focus group interview confirmed several of the practices emerging from the quantitative survey, provided additional detail for certain responses and suggested new issues requiring further investigation. For example, chicken was confirmed as a very popular meat, being eaten frequently for Sunday lunch. Children preferred eating the chicken legs with “round”

(boiled or roasted) potatoes or mashed potatoes. Meat was generally accompanied by potatoes and either carrots, tomatoes or lettuce. Rabbit was frequently eaten by these children hailing from a rural village. The children described it as either being prepared as a stew, as being served with a garlic and wine gravy, or as being baked. Tortellini were particularly popular as an After-School or Weekday Supper dish, served with white sauce, in broth, or on their own. Lasagna was both a weekday and Sunday dish; however, ross il-forn and mqarrun were mainly consumed on Sundays. Breakfast cereals with milk were further confirmed as a common After-School food. A popular dairy food was chocolate or vanilla yoghurt, often eaten for Breakfast or After School. Tea was generally accompanied by biscuits and cookies. Traditional tea-time sweets such as ‘Number 8s’ and ‘Fingers’ were rarely consumed, and then only at grandparents.

Some of the food practices mentioned, or issues implied during the interview were not that evident from the survey results. For example, children were very much aware of the ingredients in the foods they ate and of the different serving styles. Consumption of

traditional foods was very much linked to availability and to provision by grandparents. Also, children used food packaging as a tool to identify consumed food items. These findings were noted for further exploration in later stages of the research.

3.2.2.8.4 Less Commonly Consumed Foods And Drinks

As a follow-up to insights emerging from the focus group interview, I also identified a set of foods which were less commonly consumed by Maltese children and which comprised foods and drinks with different culture-cuisine orientations. For example, some of the food items mentioned by the focus group interviewees, such as ricotta-stuffed pasta shells, timpana, tortellini in broth, baked pigeon with potatoes and wine sauce were only mentioned by a few of the survey respondents. These items were mainly traditional Maltese foods and the fact that they were mentioned by children from a rural area could have been indicative of regional influence. This is in contrast to the study conducted with American-Indian children in the US where the researchers actually commented on the fact that there was no suggestion of geographic variability in the list of top 20 consumed foods (Gittelsohn et al, 2000).

Other Maltese traditional food which I had assumed were generally available and popular, but were not mentioned as commonly consumed by the surveyed children included ftira, galletti and cheese, bragjoli, stuffat, mqaret and qaghaq. It could be that these foods were no longer being offered to Maltese children for various reasons, or that the children did not know their name. I therefore decided that later on in the research process I would try to establish whether some of these foods were common components of Maltese children’s diets and what influenced their intake.

3.2.2.9 Conclusions

Stage 2 of the research provided the data with which to build a child- and culture-sensitive research tool for use in the following stage. It was clear that having adopted this grounded approach to establish a database of foods and drinks consumed by Maltese 7-8-year-old schoolchildren was a worthwhile strategy. Another US study on dietary acculturation subsequently confirmed the usefulness of such formative research to identify typical dietary habits of less-studied populations (Satia-Abouta et al., 2002).

This stage of my study offered a good insight into Maltese children’s food intake in different settings. In general, children tended to consume a variety of foods and drinks, a particular group of which stood out as being frequently consumed in several of the different settings. A culture-cuisine bias in relation to consumption in different settings emerged once again.

There were no strong discrepancies between top consumed and top preferred foods, except with regard to certain Maltese traditional dishes and pizza.

This brief experience provided me with a number of lessons on focus group facilitation, including that a limited number of topics should be chosen for the interview in order to allow time for elaboration and tangential exploration if necessary; and that working with a smaller group of children may be more productive by ensuring a more balanced participation and better management of disruptions. However, the experience also proved that using focus groups with Maltese children could work and that this research method did provide much

‘rich description’ to complement quantitative data.

3.2.2.10 Limitations

The survey was conducted with a small sample of children attending eight different schools.

Despite efforts to ensure the participation of children from different regional and school type backgrounds, the food and drink consumption of these children may not have reflected the dietary practices of the universal population. The data was collected in a single session within a specific period so that children’s responses may have had a seasonal bias reflecting currently available food products, especially fresh produce. Alternative criteria for

classification of the foodstuffs into food groups during analysis may have resulted in different counts and frequencies and hence a different ranking of the top six foods and beverages.

There were a few drawbacks with the methods and tools used (see Table 34) and these would have to be addressed in later stages of the research if similar techniques were used.

TABLE 34

Limitations In The Methods And Tools Used In Stage 2 Of The Research

• Difficulty in monitoring all the children during completion of the research tool, despite having the assistance of the class teacher or another person in the classroom

• Children having to write the names of several foods and drinks on the research tool, which may have hindered accuracy of responses and certainly made the task very time intensive

• Children having difficulty listing more than one complete meal for each consumption setting

• Possible lack of differentiation by the children between meals for Weekday Evening and meals for Saturday Lunch

• The pedagogically unethical rule of asking the children not to be concerned about correct spelling whilst completing the research tool

• Too large a group size for the focus group interview

• Being ambitious regarding the number of questions to be covered during the focus group interview

3.2.3 Stage 3: Large Scale Survey Of Maltese Children’s Food Consumption Patterns