Due to a combination of low compliance and readability issues with hand-written responses to the CIQ questionnaires returned to the research team, we were unable to conduct a qualitative analysis of data from this instrument.
Focus Group Interview
Each child that completed the EAPF program was accompanied by one of their caregivers, which resulted in a total of four focus group participants. Participants’ responses to the focus group questions yielded four major categories: (1) equine contributions to participant experiences, (2) group climate, (3) learning outcomes, and (4) improving the group experience.
• Category One: Equine Contributions to Participant Experiences
Both child and caregiver participants described the inclusion of horses as a motivating factor to attend treatment sessions. One caregiver reported that coming to sessions was “a reward” for her child, and the other caregiver described the presence of horses as “something [for him] to look forward to” after school. Caregivers also indicated that their children developed feelings of affinity toward the horses. One caregiver reported that she expected her child to be nervous around horses, “So the way he took to [the horse] was kind of surprising to me.” She also noted that after the first session, her child would excitedly tell her, “Don’t forget Friday; don’t forget Friday!”, which further illuminated the child’s interest in seeing his horse again.
Specific horse–human interactions also appeared to contribute to the children and caregivers’ enjoyment of the treatment sessions. Both children stated that they liked the horseback riding sessions. In particular, one child elaborated that his favorite equine-focused activity was learning to ride his horse through an obstacle course. The other child participant mentioned that he also liked leading his horse. The caregivers reported that grooming horses with their children was a fun activity. One caregiver stated that she liked how the grooming activity provided a special opportunity for her to bond with her son, “I liked that connection, so umm; I like any connection I can get with him.” The family horse grooming activity appeared to be a particularly salient experience for one of the child participants. He spoke up after his caregiver reported that grooming “was fun” to mention that he got to show one of his caregivers how to clean the horse’s hooves. This statement suggested to us that the child may have felt a sense of pride about his ability to master this skill and teach it to his caregiver.
• Category Two: Group Climate
The category of group climate encompassed aspects of the multi-family group therapy format that fostered a positive learning environment reflective of care and support among group members and the group leaders. The caregivers and one child participant voiced a preference for the multi-family group format, while the other child participant did not verbalize a preference. Both caregivers reported that the group format allowed them to share advice with each other regarding strategies for healthy eating and exercise. A caregiver speaking on behalf of her partner, who was absent from the interview, stated that, “he liked the discussions, and everybody talking, getting other family information, and trying to use that helpful information on both sides.” Participants also described how the program facilitators contributed to the positive group climate. For example, when asked about what it was like to work with the facilitators, one caregiver said, “It was awesome. I liked it… they made you feel comfortable and if you didn’t understand something, they’d help you understand it better.” On a similar vein, one of the child participants mentioned that the facilitators were “good listeners” and “they did a lot of good things for us, they’re kind, helpful…” Lastly, evidence of a positive group climate was found in a caregiver’s comment that, “We enjoyed it. It gave [my child] something to look forward to on Fridays, and [gave] him a goal-you know, to work for, and make the right choices.”
• Category Three: Learning Outcomes
The category, learning outcomes, reflected the ways in which curriculum topics and equine-assisted activities contributed to children’s lifestyle changes and the successes and challenges that families experienced when applying the curriculum content at home. Evidence of participants’ learning outcomes were derived from their explicit statements and other noteworthy responses to moderator questions. For example, when asked about ways to improve the group experience, a child participant suggested we include a “yellow food” snack sometimes, and the other child suggested “apples” as the specific snack food to include. The children’s input clearly demonstrated that that they understood the Traffic Light System, which was a topic designed to help children make healthier food choices. The salience of this learning outcome, and the helpfulness of this particular topic, was supported by one parent sharing that “we talk about the traffic light all the time” and her report that her child had success in choosing healthy foods:
Like when we go out to eat, cause we’re all very busy, so we eat out a lot. So he’s started making better decisions. Like, he would have a salad, or just a, not a double meat hamburger, you know, like he would start making conscious decisions, uh, vegetables instead of fries, so, but he did it on his own, like I wouldn’t have to remind him.
In response to this sharing, the other caregiver followed up with a statement that suggested her child also had learned how to use the Traffic Light System to monitor his eating habits. She noted that, “Yeah, I’d have to say [my son] noticed it too, like, ‘I can’t have that.’”
Regarding topics participants mentioned as most helpful, one caregiver initially reflected that all the topics were “good” and in particular, she thought the topic on emotions and eating was helpful, implying that boredom may sometimes contribute to her child’s eating habits, “We notice his increase of eating, and it’s more than what it is when we have a busy day.” One child voiced agreement that the discussions about the Traffic Light System and emotions and eating were “good”, and he also found the content on bullying solutions to be a helpful topic. Participants also described specific equine-assisted activities that supported their learning process. Specifically, learning to redirect the horses’ attention away from eating grass during a leading activity helped one child learn about stimulus control. In addition, the other child’s caregiver explained that learning to lead the horses taught her child patience, which she felt was related to sticking with lifestyle changes. She linked developing patience to a particular challenge she experienced with her child regarding his follow-through with portion control. Lastly, both caregivers agreed that practicing the skill of praise and reward during one of the children’s horseback riding sessions was a helpful activity. One caregiver stated, “Oh yeah, the praise part was awesome. Doing the praise worked really good, so, you could see it in their faces that it made their day and stuff…”
• Category Four: Improving the Group Experience
The last major category contained participants’ feedback for improving the group experience. Overall, participant feedback was focused upon logistical considerations, the group topics, and the equine activities. Both caregivers and one child voiced a preference for expanding the 8 week program to a 10 week program. Additionally, a caregiver and one of the children reported the two-hour sessions were good, and the other child said he would prefer one-hour sessions. However, he did not elaborate about his reasons for wanting the sessions to be shorter. The topic of fitness education became a focal point for discussion during the focus group. One child and both caregivers shared that they would like to learn more information about fitness, including types of fitness activities and how to make a fitness schedule. They also expressed a desire to do a family fitness activity with the horses. One of the children and his caregiver also expressed that they wanted more time with the horses during the program. Finally, one caregiver suggested it might be helpful in the future for the curriculum to include information specifically about the negative health consequences associated with unhealthy eating and sedentary behavior.