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Table 2 Themes and illustrative quotes for focus group discussions

From: Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study 

Theme

Type of participant and participant quotes

Feasibility

• [Emerging Adult:] “I feel like it’s a pretty easy system to understand, especially when it’s laid out side-by-side…I feel like it’s like really clear…And a good way of kind of thinking through those things”

• [Parent:] “Yeah, I like it. I like it how they just give you the basics, the questions. They're answering our basic questions and then the program…separates their social network for them. And then it’s easy to follow”

• [Emerging Adult:] “I feel like it’s still a little confusing, just a tad bit”

Acceptability

(Discussions of similar community led social network mapping exercises)

•[Provider:] “We did an activity like this with some transitional-age (youth). And what we did was…talking circles…to really kind of identify their social network”

• [Provider:] “Each person got a big poster paper…And what we were trying to do really was create a support system for who was there. So, our goal is…to understand we were there in a good way and trying to create positive connections”

• [Emerging Adult:] “If it was a strong connection, there was like a solid line. And then if there was like, I know them, they're there all the time, but I don't really talk to them, it was like a dotted line and stuff like that…they each did their own. And then they discussed it at the end”

Relevance

(Discussion of interest in seeing network diagrams)

• [Emerging Adult:] “I would be curious to see how many people…use [substances] in my circle”

• [Emerging Adult:] “(It) would kind of make them think of…their life choices”

(Discussion of relevance of the example network diagram)

• [Emerging Adult] “Yeah, big time. I think especially having them right next to each other. It makes me think about, especially …with the whole “likely to use”, her being the center of it all, but then also engaging in traditional practices, just wanting to figure out more about her and why that is and how that works….I think it makes me want to know more about these people and their relationships and how those two things do interact with each other, because it’s interesting that you can go one of two ways almost in both of those, that there’s all these different splits that you can take and how knowing other people would affect that”

• [Emerging Adult:] “I’m actually going to say this is actually pretty true for me, which is creepy. Because I have no network, basically…I really don’t like to interact with people…I stay sober…And I’m super into traditional practices and ceremonial ways and stuff”

• [Emerging Adult:] “Well, I feel like I’m a “Karen” because I go out a lot. And I have like my group of friends that I go to music festivals with or raves

• [Emerging Adult:] “Is it talking about in our substance use…the people that we’re likely to communicate with mostly likely are going to be using…on a regular basis? Because that’s totally true…I don’t really associate with anybody that’s sober…when I’m high, I really don’t. I mean, I don’t want to be around people who are sober. So, that kind of makes sense”

• [Provider:] “So like for me, the center one with the big red circles, I kind of see that as like the home environment and the community. So, let’s just say you take one of those people out of that environment, right. They go to get help, substance abuse help. And the thing is that nothing is really changing there in the community in the home. And you got somebody over here getting well or you know trying to make changes. And for a young adult, most of them that I come across are not self-sufficient. So, they go back to the same place. And so you have a continuous cycle that’s happening"

Usefulness

(Q: Would the diagrams help participants think about their choices?)

• [Parent:] “It’ll make them think…maybe Suzy and Johnny aren’t the best people to be with”

• [Emerging Adult:] “(Yes) if it was drawn out for each individual person and they were serious about considering becoming sober or improving their life in any way, shape, or form…Like these are like the people around me (that) it’s really not in my best interest to be hanging around”

• [Emerging Adult:] “The social networks was a really good idea, and the diagrams…helped visualize how your social network affects you. But I also think maybe we could talk about…parental figures or older cousins that you might see or other family members…someone who may be an alcoholic or someone else who may have a drug addiction. ‘Cause it’s not just like your peers, your friends that you’re hanging out with, it’s also like your family figures that are important in your life”

• [Provider:] “Maybe I need to work on this relationship with this person because this person isn’t doing it…maybe I need to focus in on that and maybe connect with that person a little bit more

• [Parent] “If the child…put down the people that are in their lives…then they could start highlighting, if they had a problem, who could they go to?”

• [Provider:] “I just want to reiterate that seeing it on paper is actually a good idea… because for somebody like me, you know, I’m just trying to think, okay, who’s using, who’s not and trying to think of the whole network. Well, if you put it on paper you can see, okay, well, this is my network and for like guys in general, they're very visual”

• [Parent:] “I think this would really help with young adults just because sometimes they're displaced out of their homes or they're growing into adults. And they're leaving their homes and their social networks are changing… you'll show them how they're moving and how they can in the future move”

• [Provider:] “One of the conversations we had about staying clean is that more than likely you’ll lose a lot of those friends as you move forward in your sobriety. So, this really is a good way to put into perspective because it’s a visual”

• [Parent:] “They could start eliminating and choosing a different, alternate, like getting a different result, if you're eliminating these negative people, your result's going to be a better chance that you're going to not repeat the same mistakes over”

• [Provider:] “It could say what are some friends and relatives I shouldn’t be around and then do you have a choice not to be around them. I mean, if your mother is the one that’s using substances, you don’t really have a choice. And so, determine, like, where are my strengths, where do I have choice? Where can I exercise choice? You know, so they can get used to that habit. I have a choice to select people sometimes, sometimes I don’t”

• [Provider:] “I like it because I don’t think we teach our youth refusal skills enough or critical thinking skills enough… because we’re so community-minded, Native people, sometimes we don’t rate our relatives or rate our friends and in this world we do need to say, “Hey, we love Uncle So-and-So, but we don’t go hang out at their house because they always have alcohol.” And to get our youth to start thinking that way…our traditional values are that we love everybody, and we value everybody, and we lift everybody up, but there are some people you don’t want to hang out with if you’re a young person and they’re going to be exposing you to alcohol or other unhealthy behaviors. So, I’d like it because it sort of gets into refusal skills and critical thinking skills”

(Discussion of using diagrams to track changes over time)

• [Parent:] “It changes over time like a progress chart…It can be good because it can show…how you've shifted and who you interact with”

• [Provider:] “It would be cool for them to see how it changes, because they'll be able to look at it over time and that can be really powerful…They'll see, oh look, I made these changes in my network and because of that, I'm not using as much”

Challenges

• [Provider:] “How do we do that in a way where it’s like that diagram isn’t going to immediately shut people down…I was looking at that and I’m like, who’s actually not using substances? And a lot of my dots would be red, you know what I mean? So, I’m like thinking to myself, as a young person, I would feel like, dang, I don’t even have anybody in my network—I would isolate myself from my whole family if I was to…try to transition”

• [Provider:] “So when you say, ‘Hey, bring your healthy network… ‘Well, yeah, I don’t have anyone, so I'm just not going to come at all.’…Because obviously if they’re at-risk and within this group, they’re not going to have those healthy connections”

• [Emerging Adult:] “I think I've witnessed… some people…stick with that group because that's like their only friends…try to avoid those people, but it can be difficult”

• [Emerging Adult:] “I think a barrier, too…There’s elders that are also in their addiction…So, it’s hard to have both…others within the family could make you feel like that there’s almost like a betrayal. Now, you’re leaving us. You’re better than us”