Using metaphorical techniques in focus groups to uncover mothers' feelings about family meals

Numerous causes of being overweight in children have been well documented (Anderson & Butcher, 2006). One contributing factor that has gained attention in recent years is decreased frequency of family meals (Gable et al., 2007). Eating meals together is one aspect of family life that has been shown to benefit young people (Eisenberg et al., 2004). Family meals offer routine and consistency (Wolin & Bennett, 1984), as well as provide an opportunity to teach children about manners, nutrition, and healthy eating habits (Gillman et al., 2000).

In the United States, federal, state and local governments offer many nutrition education programs and educational materials pertaining to family meals that are often geared toward people with low incomes and their children. Cooperative Extension in each state teaches their program participants skills needed to enhance family meals (Mississippi State University Extension Service, 2006) and provides newsletters with tips for quality family meals (Iowa State University, 2003). The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) also provides low-income mothers with information regarding the benefits of family meals (WIC Learning Center, 2007). Though an abundance of traditional educational materials promoting family meals is readily available to the populations these agencies serve, most of it is factual information, the weakest form of persuasion. The impact of this education on behavior change is rarely evaluated and the effectiveness of traditional nutrition education based solely on logic and fact has also been questioned. Other approaches need trial and evaluation.

One such approach that has not been tested in nutrition education to promote family meals is emotion-based messaging. Emotion-based messages in advertising and marketing are designed to evoke an emotional response in an individual to promote the purchase of a product or service, or a change in behavior. In a 2000 study by Biener, et al., the thematic content of a message, or advertisement, and its emotional content were found to be equally important in the development of a message. It has been stated that if an idea does not have emotional significance for us, we are not likely to store it and be able to recall it at a later time (Zaltman, 2003). Social marketing campaigns promoting physical activity (Peterson et al., 2005), breast self-examinations (Prentice-Dunn, et al., 2001), the serious consequences of smoking (Farrelly et al., 2002), awareness of the dangers of second-hand smoke (King, et al., 2003), breastfeeding (Lindenberger & Bryant, 2000), and macro- and micro-nutrient intake (de Pee et al., 1998; Verrall, et al., 2006) have also experienced success utilizing messages combining emotional content with a brief factual message.

Uncovering underlying emotions or feelings related to nutrition behaviors is not something that is usually done in traditional types of quantitative research. For example, the barriers to family meals have been reported to be such things as the family being too busy to get together more often, long commutes, conflicting schedules of the family members, lack of desire to eat together, and television watching (The National Center on Addiction and Substance Abuse at Columbia University (CASA), 2006). These reasons, typically provided by way of a survey, may be considered only "surface" reasons for choosing not to participate in family meals. Targeting them rather than the underlying emotional reasons for choosing not to have more family meals may be one reason for a lack of success in changing this behavior with typical nutrition education methods.

The purpose of this research was to uncover the emotional reasons, sometimes referred to as emotional pulse points, lying beneath "surface" reasons for mothers' choosing or not choosing to have more family meals. This would then serve as the first step to developing emotion-based messages promoting the benefits of family meals.

Focus groups were conducted with low-income mothers, using innovative methodologies such as metaphorical techniques to reveal their thoughts and feelings towards family meals. Metaphorical techniques are methods used to explore an abstract concept, such as a brand's image or life experience, in terms of a more concrete concept, such as a photograph of a specific object or scene (Bystedt et al., 2003). Examples of metaphorical techniques include having subjects quickly select from a variety of photographs one that represents how they feel about a particular subject, or naming the top three words that come to mind when one thinks of a particular subject.

Focus group interview guide

An interview guide was developed and pilot tested on a group of 12 mothers. Only minor changes to the interview guide were needed for question clarity. Content validation of the guide was carried out by an expert review panel consisting of Cooperative Extension professionals, university faculty in nutrition and health promotion, and a nationally-known expert on emotion-based messaging. The guide contained open-ended questions with questions 1 and 2 involving metaphorical technique activities (Fig. 1).

Fig. 1
Focus Group Interview Guide

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For the first question, the mothers were asked to select a photograph that defined the essence of family to them from an assortment of photographs (58 in our case) randomly chosen by the researchers. These photographs were composed of a variety of objects or scenes and included such things as animals, buildings, nature scenes, landmarks, etc. The women were given 30 seconds to select a photograph. (This metaphorical technique does not require a specific number of pictures, or prescribed types and amounts, but rather a diversity of subject matter and enough pictures so that participants have a variety from which to choose. It's suggested that human images are avoided to encourage participants to think more deeply about how a certain object or scene brings to mind associations that can define family. The time limit is to encourage an emotional choice).

In the second question, the mothers were then asked to list and explain the top three words that came to mind when they thought of the words "family meals." The remaining four questions asked used guided imagery to get participants to reflect on and express their thoughts about family meals.

A total of 51 mothers between the ages of 18 and 52 participated in five focus group interviews. Demographic information is presented in Table 1.

Table 1
Demographic Information of Focus Group Participants

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Stress described family meals to many women across all groups, which is why many of these women choose not to have family meals. As in previous surveys (The National Center on Addiction and Substance Abuse at Columbia University (CASA), 2006), barriers to providing family meals contributing to the stress felt by our participants included late working hours, after-school activities of the children, conflicting schedules of the family members, lack of desire to eat together (primarily the children's lack of desire), and television watching. It is interesting to note that some of our white participants reported watching television instead of dining with their families, while some of our black participants reported watching TV while dining with their families as part of their daily routine. Similar to the findings of Neumark-Sztainer et al. (2003), our participants reported a decrease in the frequency of family meals as their children moved from middle school to high school.

However, unlike in the 2006 CASA survey or study by Neumark-Sztainer et al. (2003), the current study revealed many "beneath-the-surface" reasons for not choosing to have family meals. For instance, some mentioned that they cannot afford what society perceives as proper meals for a family, which some admitted left them feeling ashamed and bored with the food choices. These findings underscore the significance of incorporating metaphorical techniques in qualitative research using focus groups, alone or as a supplement to research using surveys, to reach the underlying feelings of participants. A woman from our study, for instance, may have felt ashamed to write "I don't provide meals because I cannot afford food" or "because I don't have my own home" to describe her barriers on a survey about providing family meals. It is much easier to check a box next to or write "conflicting schedules," for instance, as a reason for not having family meals. It is less shameful to offer a socially desirable reply like "because we don't have time" in a straightforward, question-and-answer style focus group interview rather than communicating "Our mealtime is chaotic and usually family members are yelling at each other" via activities in focus groups employing metaphorical techniques.

A major finding from this study indicates that mothers who most often experienced family meals with their families during childhood tended to prioritize family meals the most, and often experienced guilt or a feeling of "missing out" when they were not able to have family meals. Also, the women who longed for the routine of family meals in childhood but did not have them also tended to prioritize family meals with their own children. It seemed innately important to these women to communicate and educate their children over a meal, as none of the women reported being familiar with the aforementioned research findings on the benefits of family meals. These mothers tended to speak more about proper nutrition than the mothers who felt family meals were unimportant. Still, other participants (both white and Black) equated family meals with special meals like barbeques and Thanksgiving, involving extended family. These women tended to not place any importance on more frequent family meals.

Shift work was common in all of the groups. Again, women who prioritized family meals made an effort to share breakfast, lunch, or dinner with their families. Even for the Black mothers who did not prioritize daily family meals, coming together for Sunday dinner was very common, and would often include the extended family or neighbors and friends.

When conducting these interviews, it became apparent that many of the women have a very realistic view towards life. However, they felt that many parents do not. For instance, it was mentioned that many parents do not face the reality of the consequences of their child's obesity, or not having family meals. When we asked their opinion on what might encourage parents to have more family meals, it came as a surprise that the women often commented that perhaps some parents need to "face reality," and felt that a message incorporating "guilt or fear might trigger something in these parents to change their behavior and choose to have family meal". In addition, some women thought that people may respond better to a message "pushing reality" because many people respond well to reality given the massive popularity of reality television and fearful, easy-to-recall anti-drug advertising.

Guilt in emotion-based messaging may work because the act of providing family meals is valued by many mothers, yet many are simply not doing it. Therefore, in using a negative emotion of guilt, this value is likely to surface especially if she feels she is not living up to the standards of a good mother and provider. She may be able to turn this negative feeling about her actions into a positive one (feeling successful as a mother) by making a positive impact on her children's lives via family meals.

Evoking feelings of fear and guilt in social marketing advertisements has been shown to be positively correlated with behavior change. King et al. (2003) reported that messages instilling guilt in smokers positively affected their knowledge of the dangers of second-hand smoke and future intentions to protect others, especially children, from secondhand smoke. Exposure to the national "truth" campaign to decrease youth tobacco use was found to be associated with an increase in anti-tobacco attitudes and beliefs (Farrelly et al., 2002). A well-known "truth" commercial known as "Body Bags" featured young people piling body bags outside of a tobacco company's headquarters, and using megaphones to broadcast that the bags represent the 1200 people killed daily by tobacco use.

Prentice-Dunn et al. (2001) found that women in their study were more likely to perform breast self-examinations after viewing threatening, fearful information about breast cancer, but only if this information was followed by coping information on how to control the sensed danger of the disease. Thus, the use of threatening information in a message can be effective so long as there is an instructional or educational message to accompany it. In the case of a guilt-evoking advertisement to promote family meals, an educational and instructional message would inform the viewer of how to rectify the perceived problem of not currently providing meals and spending meals with their families.

The mothers in this study felt that it would be necessary to include a small tagline that would make a mother experience a twinge of guilt and ultimately provide more family meals. The educational message accompanying the small tagline would come from published research studies. A series of advertisements featuring a variety of research findings is essential if the advertisement budget permits, as it was observed that the mothers were more emotionally affected by certain benefits to family meals and not by others.

In order to make a lasting impression on a larger number of mothers viewing the advertisement, and ultimately make family meals more appealing to them, it is not advised to solely promote better nutrition for their children as a reason to provide family meals in this population. In observing many of these women and listening to their comments, they have greater issues to face in their daily lives than offering balanced meals. Some of these included "keeping their children out of trouble" and "keeping them safe" which seemed to be real issues in their social circles or in their neighborhoods. They also want to be "good moms" and "do what's best" for their kids. Based on our findings, some suggested educational messages to promote family meals might be:

If the mothers are successfully affected by these messages and choose to provide more meals, the nutrition-based benefits associated with family meals will also presumably make a positive impact on the children. Nutrition-related benefits would not, however, be the primary motivator for the mother to begin to offer family meals.