Message Testing - interview screener

Formative Research and Tool Development

OMB No. 0920-0840, Expiration 31 January 2013

Title of Sub-collection:

Development of HIV Prevention Decision Support Messages for Men Who Have Sex with Men and Heterosexuals

Attachment 3

Qualitative Interview Screener

Contact Person:

Donata Green, PhD

1600 Clifton Rd. NE

Mailstop E-49

Atlanta, GA 30329

Telephone: (404) 639-3869

Fax: (404) 639-2007

E-mail: dqg7@cdc.gov

Form Approved

OMB No. 0920-0840

Expiration Date 01/31/2013

Development of HIV Prevention Decision Support Messages for Men Who Have Sex with Men and Heterosexuals

Qualitative Interview Screener

Public reporting burden of this collection of information 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. 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0840)

Development of HIV Prevention Decision Support Messages

for Men Who Have Sex with Men and Heterosexuals

(OMB No. 0920-0840, Expiration 31 January 2013)

Qualitative Interview Screener

Introduction

Hello, my name is _______________ and I’m from (name of company). We are calling on behalf of RTI International, a non-profit research organization, and the Centers for Disease Control and Prevention (CDC). We are not selling or promoting any product. We are calling to recruit men and women to take part in a research study about HIV and other health topics.

The purpose of the research is to gain your opinions about safe sex information and messages.

To see if you are eligible for this study, I need to ask you some questions. If you are eligible and choose to be in the study, all of your comments will be kept private. In appreciation for your participation, you will receive a token of appreciation.

My questions will only take a few minutes. May I proceed?

Background Information

1. How old are you?

Age__________[if under 18 terminate]

1. Don’t know [Terminate]

2. Refuse to answer [Terminate]

2. What is your gender?

1. Male

2. Female

3. Transgender or Transsexual

3. Other [Specify:] [Terminate]

4. Don’t know [Terminate]

5. Refuse to answer [Terminate]

3. Are you of Hispanic or Latino origin? [recruit mix]

1. Yes

2. No

3. Don’t know

4. Refuse to answer

4. Which of the following best describes your race? [recruit mix]

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or Other Pacific Islander

5. American Indian or Alaska Native

6. Other race [Specify: ]

7. Don’t know

8. Refuse to answer

5. What is the highest grade or year of school you finished?

1. Never attended school or only attended kindergarten

2. Grades 1 through 8 (elementary)

3. Some high school

4. High school graduate (includes GED)

5. Some college or technical school

6. College or technical school graduate

7. Don’t know

8. Refuse to answer

6. Which best describes your total personal income during the past year?

1. Less than $21,000

2. $21,000 to $30,000

3. $31,000 to $40,000

4. $41,000 to $50,000

5. $51,000 or more

6. Don’t know

7. Refuse to answer

7. Which do you consider yourself to be?

1. Gay, lesbian, homosexual, or same gender loving

2. Bisexual or two spirited

3. Straight or heterosexual

4. Other [Specify: ] [Terminate]

5. None of the above/unsure [Terminate]

6. Don’t know [Terminate]

7. Refuse to answer [Terminate]

8. What is your current relationship status? Are you…? [If a participant identifies herself as a woman and says that she is in a relationship or married to a woman, she would be terminated.]

1. Single

2. Married to a man

3. Married to a woman

4. In a relationship with a man

5. In a relationship with a woman

6. Divorced or widowed

7. Don’t know

8. Refuse to answer

9. What is your ZIP code?

1. Please fill in:__________________

A.10 Have you ever been tested for HIV?

1. Yes

2. No

3. Don’t know

4. Decline to answer

A.11 The next question is about the result of your HIV test. We are recruiting people who are positive and negative for the study. With that in mind, what was the result of your most recent HIV test? (Read options.)

1. I tested positive for HIV

2. I tested negative for HIV

3. My results were unclear / Don’t Know

4. I never got my results

5. Decline to answer

11a. [If positive] When did you first test positive? DATE (mm/dd/yy):__________

1. More than 5 years ago

2. 5 or less years ago

3. Don’t Know

4. Decline to answer

11b. [If negative or unknown] When was your last HIV test?

5. Three or more years ago

6. Within the past 12 months

7. Between 1 and 3 years ago

8. Don’t Know

9. Decline to answer

High-Risk Behaviors

A.12 Did you have [oral/vaginal/anal] sex with any of your [female/male] partner(s) in the past [INSERT TIME FRAME]?

1. Yes

2. No

3. Don’t know

4. Refuse to answer

A.13 How often did you and your partners use a condom?

1. Never

2. Occasionally

3. Usually

4. Always

5. Don’t know

6. Refuse to answer

A.14 In the past 12 months, did you have unprotected oral, vaginal, or anal sex with any non-main partners – that is, somebody who you did not consider to be a spouse, significant other, or life partner ? 

1. Yes

2. No

3. Don’t know

4. Decline to answer

A.15 In the past 12 months, have you had unprotected vaginal or anal sex with a person who you knew or thought was HIV-positive? By unprotected sex, we mean any sex without a condom. [Note to screener: It does not matter if they knew at the time the partner was HIV+ or not.]

1. Yes

2. No

3. Don’t know

4. Decline to answer

A.16 In the past 12 months, have you had unprotected vaginal or anal sex with a person whose HIV status you did not know? By unprotected sex, we mean any sex without a condom.

1. Yes

2. No

3. Don’t know

4. Decline to answer

A.17 The next question is about injecting, “shooting,” or “skin popping” drugs. This means injecting drugs with a needle or a syringe yourself or having someone who isn’t a health care provider inject you. Do not include hormones, or drugs that were given or prescribed by a health care professional for things like allergies, diabetes, or HIV medications. Please remember your answer will be kept private. In the past twelve (12) months, have you injected drugs?

1. Yes

2. No

3. Don’t know

4. Decline to answer

Invitation:

Thank you for answering all of my questions. As I mentioned earlier, we are conducting a research study on behalf of the CDC regarding [INSERT TOPIC] and would like to hear your views. In order to hear them first-hand, we would like to invite you to take part in a personal interview. The interviews are being scheduled on [DAYS/DATE TBD] at a time that would be convenient for you [GIVE AVAILABLE TIMES]. The discussion will last about one hour and you may find the discussion interesting and informative. No one will attempt to sell you anything and no one will call on you for other studies as a result of your participation in this study. As a token of appreciation, you will receive $50 at the time of the interview. This is an important research effort and we hope that you will be part of it. Can we schedule your attendance?

Closing for Ineligible Participants:

Thank you for answering all of my questions. You are not eligible to be in this study because you did not meet the eligibility criteria. We value your interest in this research study. Thank you for being willing to help us.

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