This paper followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) (27).
Design
A qualitative methodology with a phenomenological study design was used to identify the beliefs, behaviours, and experiences related to eating and physical activity habits of working adults, through non-participant indirect observation (IO), focus groups (FGs) and in-depth interviews (IDIs). The non-participant IO identifies social roles and generates reflections about the details, events, or interactions that occur in the environment (28,29). FGs facilitate group interaction and discussion, enrich testimonies, and build opinions based on previous attitudes and experiences (30,31). Finally, IDIs allow understanding the specific circumstances or events that determine a person's behaviour and illustrate their experience from a key informant viewpoint. Additionally, IDIs offer greater trust and anonymity since they are individual (32,33). These methods, in conjunction, allowed the in-depth exploration of the targeted topics.
Participants and setting
The participants were workers of a company dedicated to the manufacture and marketing of wound care supplies, personal care, and baby products in the metropolitan area of Guadalajara, Jalisco, Mexico. Workers of both sexes, aged 18 to 59 years, able to read and write, with morning (7:00 am to 3:00 pm), evening (2:00 to 9:00 pm), or mixed shifts (7:00 am to 5:00 pm, or 8:00 am to 6:00 pm), and who voluntarily signed the informed consent, were included. A total of 45 employees participated: 6 in the IDIs and 39 in the FGs.
The key informants in the IDIs were 6 production supervisors (three women and three men) with a mean age of 45.26 years (SD 5.13). One of the supervisors was from the morning shift and five from the mixed shift. All participants were Jalisco natives; five of them were single, and three had a bachelor's degree (Table 1).
Thirty-nine workers participated in the focus groups (37 women and two men), mean age was 40.56 years (SD 9.66).
Table 1 Workers’ demographic characteristics (n=45)
|
|
In-depth interviews
(n=6)
|
Focus groups
(n=39)
|
Characteristics
|
Mean ± SD or n (%)
|
Mean ± SD or n (%)
|
Age (years)
|
45.26 ±5.1
|
40.56 ±9.7
|
Gender
|
Male
|
3 (50.0%)
|
2 (5.1%)
|
Female
|
3 (50.0%)
|
37 (94.9%)
|
Marital Status
|
Single
|
5 (83.3%)
|
19 (48.7%)
|
Married
|
1 (16.7%)
|
17 (43.6%)
|
Divorced
|
0 (0.0%)
|
2 (5.1%)
|
Separated
|
0 (0.0%)
|
1 (2.6%)
|
Education (highest level)
|
Elementary school (completed)
|
0 (0.0%)
|
3 (7.7%)
|
Middle school (completed)
|
2 (33.3%)
|
19 (48.7%)
|
Middle school (incomplete)
|
0 (0.0%)
|
2 (5.1%)
|
High school (completed)
|
0 (0.0%)
|
6 (15.4%)
|
Technical degree
|
1 (16.7%)
|
2 (5.1%)
|
Bachelor´s degree
|
3 (50%)
|
6 (15.4%)
|
Postgraduate
|
0 (0.0%)
|
1 (2.6%)
|
Shift
|
Morning 1
|
1 (16.7%)
|
17 (43.6%)
|
Evening2
|
0 (0.0%)
|
3 (7.7%)
|
Mixed3
|
5 (83.3%)
|
19 (48.7%)
|
SD = standard deviation
1Morning shift starts at 7:00 am and finish at 3:00 pm.
2Evening shift starts at 2:00 pm and finish at 9:00 pm.
3Mixed shift comprises two working hours of 7:00 am to 5:00 pm, or 8:00 am to 6:00 pm.
The FGs participants were blue-collar workers, assigned to two different working areas: manufacture and packaging (n = 38), as well as administrative staff (n = 7). Nineteen participants (48.71%) were single, and 19 (48.71%) worked the mixed shift. Middle school was the most frequent education level (48.72%) (Table 1). The FGs participants were assigned to four groups, based on the time availability of their workplace: focus group 1 (FG-1) included 9 participants; FG-2, 15; FG-3, 10; and FG-4, 5 participants. The FGs did not include supervisors to ensure that participants could express themselves freely. Participants did not receive any compensation, and the research team had no personal relationships with the participants before, during, or after the study.
DATA COLLECTION
Topics Guide for focus groups and interviews
The topics guide was developed and validated by experts (STC, GMO, MAM, and NBC), and was used in the FGs and IDIs. Additionally, this guide was tested in one FG and three IDIs conducted among workers of an institution different to the one in this study.
The complete guide covers 23 categories (Additional file 1); however, for this study, it was decided to include only 12 categories because these relate to eating habits (dietary experiences and nutrition, eating habits, water, sugary drinks, vegetables, fruits, fast food and processed foods, red meat, grains, legumes, alcoholic beverages) and physical activity. Four aspects were addressed for each category: beliefs, attitudes, perceptions, and knowledge. At the end of each session (FG or IDI), feedback from participants was obtained to identify doubts and to clarify concepts when needed, as recommended for the application of these techniques (34).
In-depth interviews (IDIs) and focus groups (FGs)
The FGs and IDIs sessions were conducted in a semi-structured manner according to the topics guide (previous section) and took place in the boardroom of the company, a well-known area by participants, adequately ventilated and well-lit. In each session besides participants, there was a moderator or an interviewer (for FGI or IDI, respectively), and observers. The moderator or interviewer was responsible for ensuring discussion, while the observers recorded nonverbal expressions and managed the time established for each FG and IDI session. At the beginning of the sessions, workers were welcomed; the moderator or interviewer and the two observers were introduced; then, all participants completed a registration form with sociodemographic data (name, age, education level, marital status, work area, and shift), and received an information sheet about the project and the informed consent. Approximately 5-10 minutes were provided to read the information sheet, ask questions, and sign the informed consent if they agreed to participate. Subsequently, the project (objectives and stages) and the importance of their participation were verbally explained, and authorisation for audio recording was requested.
FGs participants received a name tag and session rules were explained, which included aspects such as avoiding cellphone use and respecting others and their opinions. It was also emphasised that all personal information collected was confidential, labour repercussions would not be applicable, there were no right or wrong answers, and all opinions were important. Finally, the importance of not talking with other coworkers about the categories discussed in the sessions (to avoid influencing the responses of other participants) and the freedom to withdraw in case of feeling offended or uncomfortable, were highlighted.
IDIs’ duration was 31 minutes on average and FGs sessions lasted 37 minutes on average. In the case of FGs, a video prepared by the main researcher, illustrating a typical day of a woman with sociodemographic characteristics similar to those of the study population (single mother in her 40’s, with two children, and morning shift work from 7 am to 4 pm), portraying both healthy (consumption of water) and unhealthy habits (physical inactivity, consumption of sugary drinks, processed foods, and high-fat foods) was used to help blue-collar workers to feel confident, without judgments, and express themselves freely; then, the session was conducted according to the categories and key points of the guide. At the end of each session, specific doubts were clarified, and fruit and bottled water were offered to participants.
All researchers participating as moderators, interviewers or observers were previously trained in the data collection techniques applied. Moderators and observers made personal field notes during FGs and IDIs, where they described the impressions and reactions of participants, and methodological field notes to guarantee methodological rigour in each of the applied techniques. To ensure quality procedures, a researcher listened to the recordings after each session (FGs and IDIs) to identify issues not addressed and emphasize them in subsequent sessions to ensure saturation of information.
Indirect Observations (IO)
The research group (NBC, GMO, and MAM) conducted IO before performing FGs and IDIs. A previously developed observation guide was used, which included several key elements: workers’ sociodemographic characteristics, company actions to promote healthy habits, commonly consumed food, food availability, and observed health problems.
DATA ANALYSIS
Audio recordings were transcribed verbatim in MS Word format by an independent transcription agency (T-VOX) with a strict confidentiality protocol. Each transcript was reviewed three times by researchers: first, to familiarise themselves with its content; second, to confirm that the transcripts had no errors; and third, to perform the analysis. Data analysis was developed with a hybrid approach (inductive and deductive analysis), which explores the concepts generated by data, as well as those proposed in the conceptual framework of the interview guides (35). First, a code system based on the categories and subcategories of the research guide was developed; those codes were identified afterwards in the transcripts. The code system was extended by assigning new codes (with word “finding”) to describe categories and subcategories not included in the original guide (Additional file 1). Finally, all targeted categories and subcategories were identified in the transcripts and were linked to the theoretical framework proposed in the interview guide and to the SCT constructs (reinforcements, self-control, emotional confrontation, observational learning, outcome expectancies, and self-efficacy) (24). The coding and sorting of the data were done in MS Excel (MS Office 2016 version).
ETHICAL CONSIDERATIONS
The guidelines of the Helsinki Declaration for human research were followed to ensure respect for the dignity, rights, and well-being of participants, under ethical and scientific principles (36) . Besides, data confidentiality, absence of work repercussions, and respect for not participating were guaranteed. Moreover, each participant received a letter of informed consent. The ethical approval was obtained by the Research Ethics and Biosafety Committee of the University Center of Health Sciences (CUCS), of the Universidad de Guadalajara (UDG) with registration number CI-02319.