3 Focus Group Screener

Appendix 4: Focus Group Screener

Form Approval

OMB No. 0925-0585-04 Expires 02/28/2011

Focus Group Screener

Public reporting burden for this collection of information is estimated to average 10 minutes per response. This time includes the length of time allotted for the screening questions. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN; PRA (0925-0585). Do not return the completed form to this address.

Recruit 11 to seat 8-9 respondents in each focus group

Participant screening will be conducted over the phone. A professional recruitment vendor will contact individuals from their proprietary recruitment database. Please note that the vendor will have access to African American, Hispanic, and MSM populations.

Hello, I’m _______________ with _____________________, an independent consumer research firm. We are not selling or promoting any product or service. We are conducting a research study for the National Institutes of Health with adults to talk about health research issues. Everyone who participates in these discussions will receive $75. I would like to ask you some questions to see if you qualify for one of the discussion groups. These questions will only take a few moments to answer. The groups will be held at [Time] on [Date] in [City] and will last two hours or less. You will receive $75 when the discussion group ends. Do you have time now to answer a few questions?

Are you aged 18 or older? If no, is there anyone in the house aged 18 or older?

[If no one qualifies in the household, thank and terminate]

1. In the past 6 months have you participated in a market research study or interview where you were paid for your time and/or for providing your opinions?

( ) Yes Terminate

( ) No Continue

2. Have you or anyone in your home worked in or retired from any of the following industries?

(Read and record response)

( ) Marketing or public relations Terminate

( ) Advertising Terminate

( ) Market research Terminate

( ) Medical field (e.g., doctor, nurse, or lab or x-ray technician) Terminate

( ) Medical clinic, hospital or doctor’s office Terminate

( ) HIV/AIDS Activism/Advocacy/Service Provision Terminate

3. Are you now or have you ever participated in an HIV vaccine trial?

( ) Yes Continue

( ) No Continue

( ) Don’t know Continue

For this project, it is important that we talk to groups of people from a variety of races, ethnicities, genders and sexual orientations. The next few questions will determine if you are part of one of the groups we are still recruiting for.

4. First, which of the following best describes your gender?

( ) Female (Recruit for Female Groups Only) Skip to Question 5

( ) Male (Recruit for Heterosexual Male or MSM Groups) Skip to Question 7

( ) Other, or refuses to answer Terminate

FEMALE GENDER ONLY

5. Now I am going to ask about how you would describe your sexual orientation. Would you describe yourself as:

( ) Heterosexual Continue

( ) Bi-sexual Continue

( ) Homosexual or Lesbian Terminate

( ) Other Terminate

6. Which of the following racial/ethnic categories best describes you?

( ) African American/Black (Non-Hispanic) Skip to 10

( ) Hispanic Continue to 6a

( ) Asian Terminate

( ) Caucasian/White (Non-Hispanic) Terminate

( ) Native American Terminate

( ) Other Terminate

6a. [Ask ONLY of Hispanic respondents] And what is your family’s background? For example, are you Cuban, Dominican, Puerto Rican, Ecuadorian, Salvadoran, Mexican or something else?

( ) Cuban Continue to 6b

( ) Dominican Continue to 6b

( ) Puerto Rican Continue to 6b

( ) Ecuadorian Continue to 6b

( ) Salvadoran Continue to 6b

( ) Mexican Continue to 6b

( ) Other: RECORD: _____________________________ Continue to 6b

Monitor to ensure (1) a variety of Hispanic/Latino backgrounds are represented by the study, (2) participants in any group will be comfortable with other participants.

6b. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?

( ) English Skip to 10

( ) Spanish Skip to 10

( ) Both English and Spanish Skip to 10

( ) Other Terminate

MALE GENDER ONLY

7. Now I am going to ask about how you would describe your sexual orientation. Would you describe yourself as:

( ) Heterosexual Skip to 9

( ) Bi-sexual Continue

( ) Gay, Same Sex Loving, or Homosexual Continue

( ) Other Terminate

MSM ONLY

8. Which of the following racial/ethnic categories best describes you?

( ) African American/Black (Non-Hispanic) Skip to 10

( ) Hispanic Continue to 8a

( ) Asian Skip to 10

( ) Caucasian/White (Non-Hispanic) Skip to 10

( ) Native American Skip to 10

( ) Other Skip to 10

Recruit the following MSM groups:

Mixed MSM Groups: 4-6 Caucasian (Non-Hispanic) per group and remainder of group should be a mix of races/ethnicities

African American MSM Groups: 100% African American

Hispanic MSM Groups: 100% Hispanic

8a. [Ask ONLY of Hispanic respondents] And what is your family’s background? For example, are you Cuban, Dominican, Puerto Rican, Ecuadorian, Salvadoran, Mexican or something else?

( ) Cuban Continue to 12

( ) Dominican Continue to 12

( ) Puerto Rican Continue to 12

( ) Ecuadorian Continue to 12

( ) Salvadoran Continue to 12

( ) Mexican Continue to 12

( ) Other: RECORD: _____________________________ Continue to 12

HETEROSEXUAL MALE ONLY

9. Which of the following racial/ethnic categories best describes you?

( ) African American/Black (Non-Hispanic) Skip to 10

( ) Hispanic Continue to 9a

( ) Asian Terminate

( ) Caucasian/White (Non-Hispanic) Terminate

( ) Native American Terminate

( ) Other Terminate

9a. [Ask ONLY of Hispanic respondents] And what is your family’s background? For example, are you Cuban, Dominican, Puerto Rican, Ecuadorian, Salvadoran, Mexican or something else?

( ) Cuban Continue to 9b

( ) Dominican Continue to 9b

( ) Puerto Rican Continue to 9b

( ) Ecuadorian Continue to 9b

( ) Salvadoran Continue to 9b

( ) Mexican Continue to 9b

( ) Other: RECORD: _____________________________ Continue to 9b

Monitor to ensure (1) a variety of Hispanic/Latino backgrounds are represented by the study, (2) participants in any group will be comfortable with other participants.

9b. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?

( ) English Continue to 10

( ) Spanish Continue to 10

( ) Both English and Spanish Continue to 10

( ) Other Terminate

FOR ALL GROUPS

OK, just a few more questions for our records.

10. Please tell me your age.

(Record actual age) ___________________

( ) Age 18 to 25 Terminate

( ) Age 26 to 35 Continue

( ) Age 35+ (older than 35 years) Terminate

11. Which best describes your total annual household income?

( ) Less than $X Continue

( ) More than $X Continue

Recruit half above median income and half below median income for each audience in each location.

Tampa, FL: $42,004

Chicago, IL: $44,473

Los Angeles, CA: $46,292

12. Which of the following categories best describes your level of education?

( ) Did not graduate high school Continue

( ) Completed high school Continue

( ) Some college/technical training/associate’s degree Continue

( ) Completed college Continue

( ) Graduate degree (master’s or higher) Continue

Recruit a mix.

13. Are you currently employed full time or part-time, or are you out of work or looking for work?

( ) Full-time Continue to 13a

( ) Part-time Continue to 13a

( ) Not working Continue to 14

13a. [If employed] What company do you work for and what kind of work do you do?

SPECIFY: Employer: _________________________________________________

Note if self-employed

Work description: _____________________________________________

Please use question to ensure that groups do not include a large number of self-employed individuals.

14. Are you comfortable reading and reviewing materials in [English/Spanish]?

( ) Yes, English Continue

( ) Yes, Spanish Continue

( ) Yes, English and Spanish Continue

( ) No/Don’t know Thank and Terminate

Individuals in English groups must read English. Individuals in Bilingual English/Spanish

Groups must read English, Spanish, or both English and Spanish.

15. Finally, can you think of a television show or movie that you watched lately? Can you tell me something about what happened in the film/program and why you enjoyed it?

This question is intended to establish whether the respondent is reasonably articulate, fluent in English or Spanish, and willing to converse. If respondent is difficult to understand or has trouble communicating (e.g., “shuts down”), thank and terminate.

Invitation

Thank you for answering my questions. I would like to tell you a little more about the discussion group. The group will meet on [Date] at [Time] at our focus group facility in [CITY, GIVE ADDRESS]. The group will consist of 7-8 other people, such as yourself, and a moderator. It will meet for 2 hours. You will receive $75 for participating. Several individuals working on this research study may observe the groups from behind a one-way mirror.

So that we can start and end on time, please plan to arrive about 15 minutes early to pick up your nametag. We are counting on your participation, so please be sure to contact us as soon as possible if something comes up and you can't attend. (GIVE PHONE NUMBER).

Also, do you wear glasses or use a hearing aid? If so, please remember to bring them. Some activities will involve reading and listening.

Has hearing aid  (check here)

Has glasses  (check here)

[ONLY if respondent asks for the topic of the focus group, please tell them “HIV vaccine research.” Please record if the participant asks about this and ask if they are still interested in participating. If the answer is “no” please ask why and record the answer.]

Before we hang up, let me get the correct spelling of your name, and your address and phone numbers so we can send you a confirmation letter with directions to our facility and give you a reminder call the day of the group.

NAME______________________________

HOME PHONE______________________

ADDRESS ____________________________________________

____________________________________________

WORK PHONE____________CELL PHONE _________E-MAIL_________

Thanks, again, for your time and we'll see you at the group!

Appendix 4: Focus Group Screener 7