Sarah Stempski, MPHc Elizabeth Bennett, MPH, CHES

1. Sarah Stempski, MPHc Elizabeth Bennett, MPH, CHES CPPW Everyone Swims! Focus Group Summary December 13, 2010

2. Everyone Swims! Goal Increase widespread access to pools and water recreation throughout King County among low income and culturally/ethnically diverse populations Today’s Goal: Summarize what we have learned about family perceptions related to Everyone Swims objectives Identify barriers and opportunities most critical to meeting the ‘Everyone Swims’ goal Discuss and prioritize policy and system changes

3. In the Media A recent news headline: ‘Pool boots kids who “might change the complexion”: Campers sent packing after first visit to swim club’ July 29, 2010; NBC Philadelphia

4. Everyone Swims!’ Focus Group 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

5. Everyone Swims! Focus Groups

6. Focus Group Assessment

7. Predisposing Factors Assessed • Knowledge of scholarships • Parent or caregiver experience with swimming (including fear of pools and beaches) • Access to current information about the registration process and swimming pools • Knowledge of what to expect at swimming pools • Beliefs about swimming as a life skill • Availability of role models • Perceptions of water cleanliness and sanitation

8. Enabling Factors Assessed • Language, time and financial constraints • Ease and transparency of swimming lesson scholarship process • Ease of registration process • Ease of access to programming based on time of day • Availability of programming for special groups (ie. gender swims for Somali community, organized swims for overweight or obese children) • Access to information about swimming from a trusted source • Access to and comfort with swimwear

9. Reinforcing Factors Assessed • Experience with a swimming program, including programs for special groups • Experience with swimming teachers and pool staff (demeanor, cultural sensitivity and languages spoken) • Availability of reminder phone calls for swimming lessons • Experience of learning skills and progressing in swimming ability • Ease of reenrollment • Perception of benefits (learning new skill and exercise) as compared to costs (time, money, effort to go swimming)

10. Themes

11. Scholarships for swim programming • Focus Group Themes • Applying requires multiple tries and is embarrassing • Families what to know if they qualify before they apply • Families don’t know about scholarship opportunities Mailing scholarships helps to not feel like a stereotypical poor, single mom. The mail in would help a lot because that trickles down. You don’t want someone to say, “you’re a scholarship kid”. Doing other sports-- need to see other kids that are like them—they see on their basketball team there are other kids like them. -Odessa Brown Community Clinic Parent

12. Screening for Swim Ability “Present it as a safety issue and then give some resources. Docs should say: ‘Everyone should know how to swim.’ ‘What kind of sports do you do?’ ‘Swimming is something to look into’. “ -George Pocock Rowing Foundation Parent • 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 • Families are interested in a resource with information

13. Referrals to Pools and Water Rec Programs • Focus Group Themes • Need to lessen confusion of finding a pool • Special programs or partnerships are appreciated by those involved in programs • Clinic staff are trusted, need to give options • Families may need help with forms and what to do, esp. the first time The doctor explained it to me—I can do swimming or walking. But, it would be really nice to have person who speaks their language at the pool teaching the swimming lessons. My main concern is privacy and do not have a ride.” -Somali speaking parent focus group at Columbia Health Center

14. 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 • Birthday parties/events “It’s probably the last thing we ever think of doing because the kids don’t know how to swim and it’s much easier to take them to a soccer game.” – Seattle Children’s Spanish Speaking Parent Group “My daughter wanted a swimming party. They wanted $250—and that was only for an hour of swimming. There are too many restrictions and only an hour of swimming, small room. We opted to do something else—I could do a lot for $250!” -Odessa Brown Community Clinic Parent

15. Additional Barriers for these groups • Themes • Acceptable swimwear is important to feel included • Concern about water being clean • Finding out about swimming in places common to culture • Discrimination at pools is a concern “Barriers to our kids learning to swim: age [under 5yrs-drinking pool water]; costs; time; ratio between students and instructors arte too high (9 students to 1 instructor – parents worry about safety issue and not enough time for children to learn).” -Vietnamese speaking group at Columbia Health Center

16. Coming full circle “I would like to receive follow-up information regarding work relating to this focus group/outcomes/how this information is used.” -Vietnamese speaking group at Columbia Health Center

17. Next steps

18. Discussion and Prioritization of Ideas • Discussion of ideas for policy and systems change –clarification and addition of what’s missing • Group exercise to rate each idea: Nominal Group Process • Each person to choose top 2 ideas in each area • Scholarships • Referrals • Screenings • Special programming

19. Scholarship Policy and Systems Change Ideas • If a child is on Medicaid, automatically qualify • Can apply for scholarship online • Scholarship forms available to print from pool website • Scholarship guidelines posted online and in print • Family does not have to pay upfront for swim lessons and then be reimbursed later • Scholarship offered for family swim • Scholarship offered for open swim • Scholarships offered for swim lessons • Scholarship information is available in other languages • Swimming program information is available in other languages • Swimming program information is provided to Everyone Swims community clinics in pool catchment area • Scholarship applications are reviews and families are notified within 48 hours • Scholarship extended to community center/other physical activities • Scholarship extended to include swimming parties (perhaps as incentive) • Hold open a few evening/weekend swim lesson slots for Everyone Swims referrals until the week before • ‘Sponsor a child’ scholarship

20. Clinic to Pool Referral Ideas • Clinic provides hands on assistance to help family fill out scholarship form • Clinic has scholarship forms available • Clinic has water recreation/swimming information in waiting room • Clinics have video options to play in waiting rooms • Clinic actively gives out swimming/water recreation information • Clinic provides list of referred families to pool • Clinic fills out a “referral form” and faxes it to pool

21. Swim Ability Screening Ideas • Clinic has standard tool system in place to assess swim ability at 5-6 year old well child check • Clinic has standard tool system to assist patient (any age) interest and barriers to swimming/water recreation • Providers screen for swim ability for other ages • Clinic makes referral to water recreation/swimming when appropriate • Providers recommend swimming as a physical activity

22. Programming Policy and System Change Ideas • Clinic partners with pool/water recreation facility on a special program • Clinic partners with pool/water recreation facility on a 1-2x year Pool Party • Pool partners to offer gender only swim for girls and women • Pool partners to offer gender only swim for boys and men • Pool offers child-parent beginning swim program • Pool/clinic partner to offer special program for obese/overweight children/teens/adults • Clinic partners with pool/water partners facilitate equipment for swimming (suits, etc)

23. CPPW Everyone Swims! Thank you for your time, dedication, and insight! December 12, 2010