APPENDIX I:  FOCUS GROUP DISCUSSION GUIDE

I. Introduction  (10 minutes)

(Because we anticipate some sensitivity and concern on the part of panelists, this introduction and the first discussion topics were designed, even more than usual, to comfort the participants.)

  1. As you learned when they called you, this discussion group has to do with the topic of driving.  As you can see from looking around the room, I am especially interested in learning more about the driving practices of mature drivers.

  2. Before we learn more about what we are studying, it is important that I tell you a bit more about who I am and who I am not.

    1. I am an independent research moderator.  Role.  Objectivity.

    2. I am not connected in any way with the police, the bureau of traffic safety or other government agency nor with any part of the medical community.

  3. Therefore…

    1. You will not be asked any embarrassing questions nor for any confidential information you would not willingly volunteer.

    2. Nothing you say will be associated with you personally.  Results will be reported only for the entire group, not individually.

    3. Your driving status will not be affected in any way as a result of this discussion.

    4. You will not be approached again in the future by me or other members of the study team.

  4. Focus group protocol (stick to the topic, share the floor)

  5. Panelist introductions (generic personal introductions)

II. Topic warm-up (15 minutes)

  1. Just about everyone here has been driving for a very long time.  I know that you have seen the conditions of driving, driver attitudes, etc. change significantly.  But what about YOU?  How have you changed… physically or emotionally… changes that have effected how you drive?

  2. What are your greatest difficulties or concerns as a driver today?  What do you do about them?

    (After everyone seems comfortable with the focus group environment…)

  3. Who is the sponsor?  This discussion is sponsored by the National Highway Traffic Safety Administration.  This agency is devoted to promoting driver and highway safety. 

    What is the problem? A recent national survey among adults 65+ (not in nursing homes or hospitals) showed that 40% use 5 or more different medications per week and that 12% use 10 or more.   The Agency is interested to learn what the effects on driving performance are when people take multiple medications (including over the counter). The Agency will then use that information to create educational campaigns for the public and for physicians and pharmacists to make them aware of possible risks. If people know when they are at risk, they will be better able to make decisions about if they should drive, and where and when they may be able to drive safely.

    How will they research the topic?  There will be two phases to the research.  Tonight we start Phase I.  Phase II will come much later.  In Phase II, we will need to learn what specific medications people are taking and then actually measure their driving skills to see if there are any resulting impairments.  Again, your participation in the group is for Phase I only; we are not asking you to be involved in Phase II. What is Phase I?  Well, we think that some people may feel reluctant to discuss their medications and driving.  So, our purpose tonight is to discuss what would influence mature drivers to get involved in such research and what forms the research should take.

III. Learning what medications mature drivers take. (30 minutes)

  1. When we conduct Phase II of the research, we will need to ask people about what specific medications (prescription and over-the-counter) people take. I am not going to ask anyone tonight about your medications.  If you wish to discuss your medications, know that any thing you say is anonymous and confidential.

  2. So, the question to you is… under what conditions you would share information about your prescriptions and over-the-counter medication use.  I am going to suggest some ways to get at this, but first, do you have any thoughts or suggestions?

  3. Here are some specific ideas for collecting this information.  I am interested in knowing whether you would feel comfortable or uncomfortable being asked to do this and, if you would not participate, why not.  Remember: the results of any of these tests would be confidential and would not have any effect on your driving status.

    1. You bring all your medications in a bag to a private office away from other people.  A list would be made of them and you would be asked about when and how often you take each.  This interview would be conducted by one of the following:

      1. A family doctor or nurse.
      2. A pharmacist.
      3. A neutral research person.

      (Solicit comments both about collection method and collection personnel.)

    2. Someone would come to your home to conduct the same interview about your medications. This interview would be conducted by one of the following:

      1. A family doctor or nurse.
      2. A pharmacist.
      3. A neutral research person.

        (Solicit comments both about collection method and collection personnel.)

    3. You would fill out a survey that researchers mailed to you asking about your medications and use.

    4. You would come to a researcher's office to talk about your medications but you would not be required to bring them.  If you like, a relative or friend could come with you.

    5. With your advance permission, a researcher would send a letter to all your doctors, asking them to list all the medications they prescribed for you.  The lists would be sent back to the researcher. 

      If this is OK, would you be willing to bring your over-the-counter medications into the researcher so that they could be added to your list?

    6. Special caps would be placed on the medications you take on a regular basis.  These caps would record the date and time on each occasion that you opened the bottle.

    7. Information about your prescription drug use would be obtained from pharmacy databases.

 III B.  Card Sort Exercise (20 minutes)

  1. Here is a set of 14 cards.  Each card describes one of the ways we have just been discussing to collect information about the medications people use.

  2. Read the cards and sort them into TWO piles… One pile for those in which you WOULD participate and one pile for those in which you WOULD NOT participate.

  3. Now take the "bad pile", ones that you would not participate in.  Draw an "X" through each card in this stack. 

  4. Now take the "good pile".  Put them in order according to the method you prefer first, second best, third best and so on.  Number each card accordingly. 

IV. Learning how the medications you take may affect your driving.  (20 minutes)

  1. The point is similar to the topic we just discussed.  We would like to learn under what conditions it would be OK to have your driving skills observed and evaluated… after taking the medications you normally take.

  2. Here are some specific ideas for making these observations.  I am interested in knowing whether you would feel comfortable or uncomfortable being asked to do this and, if you would not participate, why not. Remember: the results of any of these tests would be confidential and would not have any effect on your driving status.

    1. You would drive a vehicle with dual controls, like a driver education car.  A driving instructor or occupational therapist would ride in the passenger seat as you drove.  This test might be done on:

      1. A closed course, or.
      2. On the road in traffic.

(Discuss both methodology and test venue.)

  1. You would drive your own car, again observed by a driving instructor or occupational therapist. This test might be done on:

    1. A closed course, or.
    2. On the road in traffic.

(Discuss both methodology and test venue.)

  1. You would drive your own car in traffic, with miniature audio or video recording instruments mounted in the vehicle to record you response to various driving situations.

  2. You would take a brief (20 minutes) test on computer or with paper and pencil either in your home or at an office.  This test would measure your vision, memory and physical abilities after taking your usual medication.

IV B. Learning how the medications you take may affect your driving.  (10 minutes)

  1. Here is a set of 6 cards.  Each card describes one of the ways we have just been discussing to collect information about the effects of medications on driving performance.

  2. Read the cards and sort them into TWO piles… One pile for those in which you WOULD participate and one pile for those in which you WOULD NOT participate.

  3. Now take the "bad pile", ones that you would not participate in.  Draw an "X" through each card in this stack. 

  4. Now take the "good pile".  Put them in order according to the method you prefer first, second best, third best and so on.  Number each card accordingly.

V. Conclusion (10 minutes)

  1. Based on what you know about the situation of older people driving and using multiple medications, do you feel that further study is worthwhile?

  2. Based on everything you have heard here today, what would you say was the biggest concern you might have about participating in a study like the ones discussed here today?

  3. What kinds of assurances of confidentiality would be needed for you to participate?

  4. It is very likely that the researcher would offer some form of incentive to the people participating in the study.  What would you suggest as an appropriate incentive?  Cash?  How much?  Gift certificates?  Meals at a local restaurant?  Movie or theatre passes?