According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0583-xxxx. The time required to complete this information collection is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
RTI/USDA
Labeling Focus Group Study
Screening Questionnaire
Older
Adults (60+)
[Date, Time]
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Hello, this is _____________ from [facility], a local market research firm. May I please speak to_____________?
(Hello, this is _____________ from [facility], a local market research firm.) We are working with RTI, a nonprofit research organization and the U.S. Department of Agriculture, or USDA, on a research study about cooking and would like to include your opinions. We are holding a group discussion on [date] with 7 other people like yourself. The discussion group starts at [time] and will last no longer than 2 hours. The discussion group is for research purposes only and is in no way sales related.
If you participate in this discussion group, you will receive $75 and a free gift as tokens of our appreciation. First, however, I need to ask you a few questions to see if you qualify for the study.
Record Gender — Do not ask: (Recruit at least 4 males to show in each group.)
Male
Female
1. Do you have primary or shared responsibility for grocery shopping for this household?
Yes Continue.
No Ask to speak with that person. Repeat introduction.
2. Do you have primary or shared responsibility for cooking for this household?
Yes Continue.
No Ask to speak with that person. Repeat introduction.
3. Are you currently a vegetarian; that is, you do not eat any meat and poultry?
Yes Thank the respondent and terminate.
No Continue.
4. Which
of the following categories best describes your age?
(Read
list. Recruit a mix to show in each group.)
Under 60 Thank the respondent and terminate.
60 to 65 Continue.
66 to 69 Continue.
70+ Continue.
5. How many times a week do you prepare and cook meals at home for you and your family? Would you say… (Read list.)
Less than once a week Thank the respondent and terminate.
About once a week Thank the respondent and terminate.
About twice a week Thank the respondent and terminate.
Three or more times a week Continue.
6. Which of the following foods have you purchased in the past 2 months for you and your family to eat at home? (Read list. Continue if at least two items are checked; otherwise, thank the respondent and terminate.)
Frozen TV dinner or entrée with chicken or meat
Frozen pizza with chicken or meat
Frozen
chicken, turkey, or beef pot pies
(Recruit at least 2 to
show in each group.)
Frozen
stuffed sandwiches, like Hot Pockets® or Lean Pockets®
(Recruit at least 2 to show in each group.)
Frozen boneless, breaded chicken products, such as chicken nuggets, chicken tenders, chicken patties, or stuffed chicken breasts, like chicken cordon bleu (Recruit at least 2 to show in each group.)
Frozen
prepackaged hamburger patties
(Recruit at least 2 to show
in each group.)
Raw meat and poultry
7. In the past 5 years, have you or any member of your household worked for a market research, advertising, or public relations firm?
Yes Thank the respondent and terminate.
No Continue.
8. In the past 5 years, have you or any member of your household worked in a restaurant or other foodservice industry?
Yes Thank the respondent and terminate.
No Continue.
9. In the past 5 years, have you or any member of your household worked in a food processing plant or other food industry?
Yes Thank the respondent and terminate.
No Continue.
10. In the past 5 years, have you or any member of your household worked as a doctor, nurse, dietician, or other healthcare professional?
Yes Thank the respondent and terminate.
No Continue.
11. In the past 5 years, have you or any member of your household worked for the federal government?
Yes Thank the respondent and terminate.
No Continue.
12. Have you participated in a focus group or paid research discussion group in the past 6 months?
Yes Thank the respondent and terminate.
No Continue.
13. What is the last grade of school you completed? (Read list. Recruit a mix to show in each group.)
High school graduate or less, including GED
Some college or 2-year degree
4-year college degree
Postgraduate degree
14. Are you Hispanic or Latino? (If possible, recruit at least 1 Hispanic origin to show in each group.)
Yes
No
15. What is your race? Please select one or more. (Read list. Recruit a mix to show in each group.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
16. Finally, during the focus group discussion, you will be asked to review written materials and offer your opinions; therefore, I need to ask whether you have a medical or non-medical condition that hinders your ability to read and/or understand written materials.
Yes Thank the respondent and terminate.
No Continue.
Great! You qualify for our study. The discussion group is on [date] at [time] and will last no longer than 2 hours. For your time and opinions, you will receive a $75 cash honorarium and a free gift.
17. Would you like to participate in the group discussion at [time] on [date]?
Yes Continue.
No Thank the respondent and terminate.
Great! May I please have your mailing address to send you a confirmation letter with directions before the group discussion? [Verify address and phone number.]
Thank you. That’s all the questions I have today. Please arrive at least 15 minutes prior to the group. If you have any questions or find that you are unable to attend, please call [facility’s phone number] as soon as possible. Thank you again for your time. We look forward to seeing you on [date] at [time].
Read
if necessary:
If you have any questions about
the study, you may contact Katherine Kosa of RTI at 1‑800‑334‑8571,
extension 23901. If you have concerns about how participants are
being treated in the study, you may contact RTI’s Office of
Research Protection toll-free at 1-866-214-2043.
| File Type | application/msword |
| File Title | According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond |
| Author | joconnell |
| Last Modified By | rmurphyjenkins |
| File Modified | 2010-01-25 |
| File Created | 2010-01-12 |