Knowledge of diet and blood pressure among African Americans: use of focus groups for questionnaire development

Though focus groups are widely used for development of interventions, little is known about their utility in questionnaire construction, particularly for health surveys in a south-eastern African-American population. In this study, focus groups aided in the development of questions, question sub-components, and response options identifying factors that may influence dietary behavior. Information was used for a survey of dietary knowledge, blood pressure knowledge, and measured blood pressure in a church-based, stratified random sample of middle-class African Americans in North Carolina. Each session, conducted in six churches, lasted 1-1 1/2 hours and had four to nine participants; thirty-four individuals participated. Recorded responses were reviewed and summarized by trained personnel. Results indicate that participants had a general understanding of hypertension, its risk factors, and modes of prevention. However, some misconceptions existed regarding blood pressure and sources of sodium. Television was the most common source of health information. Cost and Southern cultural traditions were deemed the major influences on dietary behavior. Many believed stress was strongly related to blood pressure. The focus group process generated useful information for developing questions about nutrition knowledge, blood pressure knowledge, and health attitudes and beliefs of the target population for the epidemiologic survey that followed.