Sarah Stempski, MPHc Elizabeth Bennett, MPH, CHES

1. Sarah Stempski, MPHc Elizabeth Bennett, MPH, CHES CPPW Everyone Swims! Phase 2: Focus Groups November 29, 2010

2. Everyone Swims! Goal Increase widespread access to pools and water recreation throughout King County among low income and culturally/ethnically diverse populations Phase 2 goal: Examine current policies and systems, and identify barriers and opportunities from the perspectives of families

3. Why we are here I. Share themes: What have families said? II. Compare themes from partners and focus groups What we’ll focus on • Linking to CPPW overall goals: • increase physical activity • decrease smoking rates • reduce health inequities • Policy and Systems Opportunities and Barriers

4. In the Media More recent news headlines ‘Blacks don’t swim’ November 1, 2010; U.S. Masters Swimming ‘Kids, adults need to get into the swim of things: Data show two key barriers prevent children from learning to swim—fear of drowning, and lack of parental encouragement’ August 28, 2010; Walla Walla Union Bulletin ‘Swimming lessons do not increase drowning risk in younger children: Study allays concern the lessons could increase risk by reducing parental vigilance’ March 2, 2009; NIH News

5. Methods • Design focus group questionnaire based on precede-proceed behavior theory identifying the predisposing, enabling and reinforcing factors associated with swimming1 • Predisposing factors are antecedents to behavioral change that provide the rational or motivation for the behavior. • Enabling factors are antecedents to behavioral or environmental change that allow a motivation to be realized. • Reinforcing factors are factors following a behavior that provide the continuing reward or incentive for the persistence of the behavior.

6. Methods • Children’s IRB approval for project exempt status • Work with partners to recruit families representing populations of focus in grant • Incentives: Focus group participants were given a grocery gift card, child care to attend the meeting, and light snacks • Meetings conducted by culturally appropriate moderator throughout November in clinics and community centers • Groups are convenience sample and not fully representative • Notes transcribed during focus group discussions • Develop themes for review with partners to identify key opportunities and barriers

7. Demographics of Focus Groups Scheduled meetings: 5 • Seattle Children’s: Spanish Speaking parents from Renton and Federal Way • Odessa Brown Community Clinic: African American Families who participate in a special swim program at Medgar Evers from south and central Seattle • Columbia Health Center (2): Somali and Vietnamese families who come to the clinic • George Pocock Rowing Foundation: Group of people who participate in boating programs

8. Behavior Theory

9. Predisposing Factors • Knowing about scholarships • Information about registration process • Beliefs about swimming as a life skill • Access to current information • Language, time and money constraints • Adult water phobias • Water cleanliness

10. Enabling Factors • Knowing what to expect at the pool • Flexible swimwear policies • Ease and transparency of scholarship process • Ease of registration process • Programming offered at multiple times • Programming offered for special groups • Information about importance of swimming from a trusted source • Having the proper equipment

11. Reinforcing Factors • Being involved in a special group program • Swim teachers and pool staff that are attentive and kind • Reminder phone calls • Learning new skills/making progress • Ease of re-enrollment • Benefits (learning new skill, exercise, etc) are perceived to outweigh the costs (time, money, effort, etc)

12. Themes (preliminary)

13. Scholarships for swim programming • Focus Group Themes • Applying requires multiple tries and is embarrassing • Qualification requirements should be listed so they know if they qualify before they apply • Families don’t know about scholarship opportunities • Recap: Partner Themes • Ensuring that swimmers value programming • Need for a more efficient approval process • Restrictions by age, programming, residency vary • Availability of funds not always advertised

14. Screening for Swim Ability • Recap: Partner Themes • Some providers are champions • Screening based on guidelines or other standardized tools • Time perceived as a barrier for some clinics • Need to have resources to provide if bring up question • Themes • Doctors are viewed as a trusted source of information about the importance swimming • Some families do not think of swimming as an activity or skill • They should have something to give to the families about swimming

15. Referrals to Pools and Water Rec Programs • Focus Group Themes • It would help lessen the confusion of finding a pool • Special programs or partnerships are appreciated by those involved in programs • Clinic staff are trusted, but need to give parents options • Recap: Partner Themes • Informal referrals (web-based searching) • Personal knowledge • Water partners unaware of referrals from clinics • Clinics need updated resources on hand • Some clinics have formalized referrals for pools

16. Programming for special populations • Themes • Parent-child swim lessons wanted, should allow multiple children with parent • Adult water phobias • Children will be less embarrassed if there are other kids like them • Gender only swims viewed as pools making effort to include all cultures • Recap: Partner Themes • Parent-child swim lessons not common • Adult water phobias • Water exercise class is attended by older populations • Partnering to provide programming for certain populations • Working hard to meet gender only swimming needs

17. Additional Barriers for these groups • Themes • Acceptable swimwear is really important to feel included • Concern about water being clean • Finding out about swimming opportunities in places common to culture • Discrimination at pools is a concern • Recap: Partner Themes • Acceptable swimwear • Great value placed on provider advice • Assumption that people know what to do at pools

18. Next steps

19. Next Steps: Immediate Action Plan • Follow-up with lessons learned from today’s meeting • II. Add to themes from remaining focus groups and be thinking about prioritizing model policies based on opportunities and barriers

20. Next Steps: Communication Plan • Develop profile of different audiences based on focus groups • Families • Physicians • Clinic staff • Pool staff • Others who influence families’ decisions related to water recreation

21. Next Steps: Communication Plan • Develop key messages for providers • Develop key messages for families • Decide what kinds of materials or communication are most likely to be effective • Test messages and materials with the audiences • Finalize materials

22. Next Steps: Action Plan  Narrow focus to the key elements of policies and systems to increase access  Prioritize policy and system components

23. CPPW Everyone Swims! Thank you for your time, dedication, and insight! November 29, 2010