La Feria vs. Fast Food

Aside from the earthquakes and the qualitative analysis trainings we’ve experienced this week, we have been trying to incorporate plentiful fruits and vegetables as a part of our everyday meal. I especially look forward to La Feria or the “street market” that takes place during the weekends. There are a wide array of fresh produce that are recognizable to us, but some comes in different shapes and sizes. The feria either takes up an entire parking lot or blocks off a long sidewalk. It attracts a lot of people that are just enjoying the scene or buying specific items. Sometimes, I’ll see dozens of individual booth selling similar things, while other vendors would sell fish, assorted flowers, personal hygiene products, books, and much more.

Since we had the fundamental experience with the fast food here, we were on the hunt for fresh foods and more traditional Chilean dishes. Most of the restaurants we found served large portions of foods with a lot of meat. We typically take the rest of what we had left to eat at home. Chile also has a diverse selection of seafood to offer since it is a country along the coastline afterall. Still, the price is not favorable to many of us and is not as accessible as the fried foods here. Many studies found that adolescents and the low SES population turn to completos (hotdogs) and fried empanadas as part of their every day diet. I can only imagine this to be true since these popular foods items can be found at almost any restaurants and street vendors for less than one US dollar.

When we investigated in the background of our research, we learned that the obesity rate is projected to rise over the next decade. At first, it was hard to pinpoint that problem right away since we recognize that smoking was much more prevalent in the city. Smoking in restaurants and bars are not strictly enforced although the public health campaign against smoking is aggressive as seen in Perlita’s post here. We can tell with careful observations of the built environment that it was apparent why people may become sedentary and opt for high density foods. Cities like Los Angeles and Santiago, where it is densely populated with road traffic can impact physical activity. I believe that developing opportunities to allow for urban open space in neighborhoods across the city and building environmentally friendly mode of transportation will contribute to public health and well-being of the community. In Chile, the shift in socioeconomic and demographic demonstrates these rapid changes; however it is great to know that institutions and policymakers are recognizing the need to take action.

Time is passing by in a blink of an eye!

We conducted our final focus group session last Friday. The focus groups became relatively easier to set up and manage each day; and we only had minor changes to our approach during the week. The women were cooperative and provided us with information that we wouldn’t normally receive from other research methodologies. We were able to gauge their reaction and opinions on the current nutritional label and newly developed warning messages samples; although there were times when the discussion would go off track. There were also dominate individuals in a couple of our focus groups who tried steering the participants overall views to her favor. As we listened to our tape recordings from our first two focus groups, we realized these issues and it became clear that it will continue to occur. For the following focus groups, Perlita did a wonderful job in reverting the conversations back to our topic of interest and creating more of an open discussion by encouraging others to share their viewpoint.

We heard many responses and deliberation throughout the discussion. For example, we would take turns showing each warning message labels and ask about their interpretation of it. While many of our participants said “Alto en Sal” and “Alto en Sodio” are interchangeable, we discovered that “Alto en Sal” is the most preferred message. “Sal” is a known ingredient and a deeply rooted term to the Chilean people before “Sodio” was introduced into their culture. In addition, I mentioned how a research publication written about the effectiveness of color use in public health campaigns piqued my interest. In turns out that white text on a black background attracted the same attention in our focus groups. We’ve noted that there were usually a general consensus for almost every topic, in which we were trying to achieve however, we needed to code our transcriptions to find the true relations and comparisons between all five of our focus group sessions.

In order to do this, we have been using the qualitative data software called ATLAS.ti. The program serves as an analysis tool to organize all of our transcript data and help create diagrams to display relationships between our codes. Since we were not as familiar with the software, Dr. Corvalan contacted one of her colleagues who had worked with it before. We were invited to an informal training session to learn about the fundamentals of the program. We learned that prior to facilitating a focus group, we needed to design a conceptual framework that contains our variables, dimensions, and sub-dimensions. This will be essential in exploring and maintaining the aims of our research. To explain this step by step procedure, we would start with the textual level or quotations/responses and transform it into the conceptual level network-building map of all of our discoveries. So far, ATLAS.ti is helping us revisit our project’s goals and we have been trying to learn about the trends and patterns of our participant’s perception. At this time, we are preparing our findings to present to the INTA staff this Thursday.

Qualitative Analysis...What Joy!

Since my last entry, we have definitely progressed so much with our research project! Last week during our second week in Chile we were able to complete all of our five focus group discussions. We weren’t able to have the total number of participants or focus groups as we had hoped, but like with all research, especially when abroad, we had to remain flexible and utilize the resources we did have. As it was my first time ever facilitating focus groups, I definitely was able to learn about the various challenges that arise during such discussions, such as participants that dominated the conversation and off-topic conversation. Although it was sometimes hard and unclear when to intervene in the conversation, it was a great hands-on experience that helped me understand the importance of gearing the conversation in the direction of providing us with answers to our overall research questions. For the purpose of our focus groups, we wanted to understand the participants’ knowledge, perception and utilization of the existing nutrition label, as well as learn about their preferences of our example warning messages, color combination options, font options and location of warning message on packaging, and how these warning messages would impact their purchasing decision.

Overall, it was great to be able to moderate all five focus group discussions, and interact directly with the participants who were providing us with their valuable opinions and feedback. Despite the smaller sample of women that participated, we still gained so much information and it was fulfilling to see our investigation unfold.

Some of the Universidad de Chile INTA (Institution of Nutrition and Food Technology) Staff that has helped us so much with our research and focus groups!

Our example warning messages with various font, color combination and locations on the packaging, as well as different messages.

Following the completion of all the focus groups, we had to begin the process of analyzing the information we gained from our focus groups. Due to our unfamiliarity with qualitative research and analysis, it seemed like a daunting and overwhelming task. We began with the tedious task of transcribing each individual discussion, in which we had to listen to our audio recordings of each focus group and write down all information provided to us. It was definitely time consuming and exhausting; especially without great audio recordings of every aspect of the discussion, in addition to it being in Spanish. We tried our best to capture all the different feedback provided to our various questions, and after hours of transcription we were able to have our focus groups on paper ready to start analysis.

Throughout the last week, we were really excited to move forward with the analysis of our program but it was essential to learn about the qualitative analysis program we have decided to use: ATLAS.ti. After two different trainings we were able to successfully code our different transcriptions for the different topics and opinions discussed. It’s definitely been hard so far and our goal is to map out the associations we see between preference of warning messages and the decision to buy a specific food product. Although, we are still not done analyzing our data nor do we have established conclusions, we already have an idea of what trends and conclusions we expect to get from our data. The reason being is that we have become so familiar with the data through carrying out the focus groups and the transcription and coding processes. Our familiarity with the trends is really cool and for me truly shows how much this project is ours! Just through these last two weeks, I have been able to learn so much about qualitative research methods and value it as a way to truly capture what a specific population thinks about a certain topic. I know this last week in Chile is going to be stressful in formulating our evidence-based conclusions and showing our map of the different associations between our variables, but I’m definitely excited to see OUR results finalized!

In addition to the challenges of learning about our qualitative analysis program, this past week was definitely challenging in different ways but can be looked at as part of my experience abroad. I caused a minor car accident when I opened a car door as another car was passing by outside of a busy intersection, resulting in broken mirrors and car doors. During that same afternoon I realized I lost my debit card, but fortunately it wasn’t used by anyone so I was able to cancel it without any additional issues. We moved into our third and final hostel for the remaining two weeks and after a few days after moving in I awoke with bug bites that I think were caused from bed bugs. Finally, we experienced the very common earthquakes that occur in Chile twice within this last weekend. The most recent one was earlier today during the afternoon and was actually a 7.2 earthquake that occurred 135 miles south of Santiago, but we were really lucky in that it didn’t actually feel that strong. However, just knowing about the devastating 8.8 quake that occurred two years ago, I was definitely scared during both small quakes and I have been thinking about how I need to be prepared in case something does happen. All and all, it has definitely been an eventful third week in Chile, although not in the best of ways, but I can only hope that as our fourth and final week begins things will be get better. Ready to stay motivated and enjoy our last few days in Santiago.

Chao!

¿Catchai?

Wow! It has already been a week and a half since Vena and I arrived in Chile and there is so much that I want to share about our experiences learning about Santiago and the Chilean culture, as well describe the successful completion of our first focus group discussion for our research project.

To start with my first impression of Santiago, I was very much surprised with how few fast food restaurants I saw considering how big of a problem obesity is in Chile. Also, since I was so overwhelmed with the presence of fast food restaurants when I visited Panama this past summer I expected to see the same thing. I quickly learned that although a fast food restaurant wasn’t on every corner, there were plenty of other restaurants or food vendors that are just as bad and very common. For example, street vendors and restaurants dedicated to the sale of the Chilean Completo can be seen everywhere! This Chilean staple is a hot dog that has many different toppings, such as mayonnaise, guacamole, “American” dressing similar to Thousand Island dressing, tomatoes, and many other options depending on the type of completo one buys. Another popular food I’ve become accustomed to see being sold throughout the streets of Santiago is mote con huesillo, which is a cold sweet peach juice with small grains of wheat at the bottom. This is definitely a favorite among Chilenos to beat the heat and cool down during these hot days of “fall”.

"Completo" with just some of the many fixings
"Mote con Huesillo"

During our first few days here in Santiago, I quickly learned about a public health problem that is prevalent among Chileans: smoking. It’s been overwhelming how often we are exposed to smoking throughout the day. On the plus side, health communication regarding the risks of smoking and it's effect on others are in full force here with very strong warning messages placed on all cigarette packaging and ads located in liquor stores/stands that sell cigarettes. Perhaps greater policy changes need to be made to supplement the health communication campaigns to further tackle the issue.

Health Communication ad against smoking in a local liquor store

As for our research project, our first week gave us the chance to meet our preceptor Dr. Camila Corvalán after months of email correspondence, and it was so exciting to know that our project was finally going to be underway. We worked on finalizing logistical details, such as recruiting participants, creating our focus group guide, scheduling focus group sessions and creating our warning label message examples. We also learned more about the Ministry of Health’s (MINSAL) current interest in the type of warning messages they want to place on food packaging, which consists of an “Alto en X” message, in which “X” represents a specific ingredient or nutrient that a specific food product may have too much of. We are using sodium as our “X” factor, and testing simple messages that explain the content is high in sodium or salt, along with additional messages that explain a health outcome associated with the excessive consumption of salt/sodium or an additional message that is conducive to changing behavior, such as moderating consumption of that specific food product. Additionally, we are going to explore what preferences and opinions our participants have regarding the message's color combination, message font and location of message on the food package.

We had our first focus group session yesterday, and I was definitely nervous since I had not facilitated such a discussion before, let alone in Spanish! Once the focus group was underway the nine mothers were very open and seemed so comfortable speaking regarding the different topics of nutrition labels and the warning message examples we presented. I think having our first few days to explore the city was key in understanding the vibe of the Chilean people and catching on to how they speak, especially since we would be directly interacting with them through the focus groups. I was able to become at least slightly familiar with words that are common among Chileans. Thankfully, our preceptor arranged for a student from the University of Chile to sit in on our focus group sessions in order to provide additional help and translation incase words specific to Chile were used, such as “catchai” which is used to mean “to understand”. It was definitely a great learning experience and awesome to have had such helpful feedback from the mothers. I can only hope that the rest of the discussions go as well as our first! We’ll keep you updated on how they go!

"Grupo Focal" not "Grupo de Enfoque"

Querido readers,

It has been a productive and incredible two weeks so far.

Last week, we begun our brainstorming sessions and facilitation guide preparation for our focus groups. We have finalized the design of our labels and appended them on the food packages.

There are four variables that we are interested in: the message, position, font, and color. "Alto en 'x' " ("High in 'x'" is the message that consumers can connect with "Bajo en x" (Low in 'x') which is already marketed by most food companies. In this case, we are using Maggi's soup powder product because of it's high sodium content. Maggi, a popular condiment used in soups and stews, contains 860mg of sodium, that's 36% of its ingredient mixed in the package. Thus, we will be testing the messages "Alto en sodio" and "Alto en sal". Additionally, a behavior (i.e limit your intake) and health risk component (i.e may cause health problems) will be discussed.

Upon designing the warning labels, we met with Professor Sonia Olivares, who gave us great advice on how to effectively communicate our messages. She emailed us some useful publications that was done by the Chilean Ministry of Health. One study investigated the use of color in campaign advertisements and shown that a black background with white text was compelling compared to other colors. I personally thought this was fascinating as it relates to my study of health communications. It will be interesting to see if the results from our focus groups are similar.

The day had finally come to meet with our first group of mothers. We had everything ready as the mothers slowly began to arrive. There was a total of 9 participants yesterday, and we hope to have a total of 40 by the end of this week. Perlita facilitated the discussion in Spanish, and a translator helped with words that may have seemed unusual to us but common for our participants to use in every day language. The discussion lasted an hour in a half, and the women were given their compensation.

Through trial and error with our first focus group, there were only a few changes that was made to our facilitation procedures, but overall, we thought that the focus group discussion went really well. As relieved as we were that everything went smoothly, Dr. Corvalan was also impressed and very happy when we debrief about our positive experience.

I hope to share a little of what we learn as we come closer to finishing our last focus group sessions. Pictures will be posted soon!

Until next time. Ciao!

Hola Desde Chile!

Perlita and I arrived in Santiago, Chile safely and are currently staying in our hostel located in the central part of downtown in Providencia. When we arrived to our hostel, we were immediately welcomed by a friendly staff member who helped us carry our luggage up to our bedroom. It is a quaint and small bedroom, but in this 90 degree weather, the humidity can be somewhat uncomfortable.

We decided to unpack partially, have dinner, and explore the surrounding area a little more. It wasn’t in our best interest to go out at night. Many places were closed and there weren’t too many people walking in the neighboring streets. Before we met with our preceptor, we had the opportunity to sight see. There were many old and historical buildings that are preserved in downtown. We are walking distance to the metro station which is very convenient to get to and from the Instituo de Nutricion y Tecnologia de los Alimentos (INTA) where we will be conducting our research. Our nearest metro station is located in the city’s main plaza called Plazas de Armas. The plaza used to be the center for political and cultural activities and is still bustling with a wide range of people. There are public concerts, comedians, preachers, chess players, and artists. We even got to see the national dance of Chile called, the “Cueca” in the Plaza de Armas.


Today, we had our first meeting with our preceptor, Dr. Camila Corvalan at INTA. Her colleague, Dr. Maria Luisa, introduced herself while Dr. Corvalan was in a meeting with the Director of INTA. Dr. Maria Luisa is also a physician who studies and researches chronic diseases such as obesity, cancer, and cardiovascular diseases. Much of their work involves working with the low-middle income population and collecting quantitative data. For the purpose of our research, we are collaborating with the Chilean Ministry of Health (MINSAL) to provide technical support for implementing the new law that regulates the publicity and labeling of foods. The law basically states that any food that contains high sodium and/or fat content will have warning messages on its food packages. They have decided not to follow the UK system’s concept of traffic color coding. For example, green represents a healthy food choice while red represents an unhealthy one. Instead, we will be developing another alternative that alerts and helps consumers distinguish between healthy and unhealthy food products through warning messages. Since, there’s not enough evidence to suggest these alternatives, Perlita and I will be collecting data through focus groups.

In our focus group, we want to understand how people, particularly mothers, understand nutritional labeling by checking, reading, interpreting it; and whether they find this useful. The second part of the focus group will be dedicated towards displaying these warning messages to our participants. Since a majority of food publicity is focused on low-middle income families, Dr. Corvalan suggested that our focus groups should be based on our participant’s educational background. Once we find that our messages are appropriate and understood by the participants, we will present the findings to MINSAL and suggest the alternatives that were based on the feedback we obtained from our focus group discussion.

This week, we will be focusing on the logistics (i.e. contacting participants, development of warning messages) so that we can begin on Monday with the focus groups discussion. We will be meeting with an expert who has experience in marketing of foods and labeling. She will be providing recommendations of the messages that will be presented on the food packages. We will also be meeting with dieticians at the office.

We are excited to be part of this team and we look forward to the progression of our study!