Form Approval
OMB No. XXXX-XXXX
Public reporting burden for this collection of information is estimated to average 20 minutes per response. This time includes the length of time allotted for the survey 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 (XXXX-XXXX). Do not return the completed form to this address.
Part 1- Screening
Can you spare a few minutes to help the National Institutes of Health develop materials about HIV/AIDS prevention?
Please use the following language for termination of screening:
“I’d like to thank you very much for your time today. We are looking to recruit a mix of people from a variety of backgrounds to help with this study. Right now we have enough people with your type of background. Again, thank you.
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 among the people we are still recruiting.
Your answers will not be connected to you and you will not be asked to share your name. You do not have to answer questions that you don’t want to. You may stop at any time. The National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health, is the sponsor of this project.
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
( ) Transgender (Recruit for Transgender Groups Only) Continue to Question 3
( ) Other, or refuses to answer Terminate
TRANSGENDER ONLY
Are you M2F/MTF (male to female) or F2M/FTM (female to male)?
( ) M2F/MTF Continue
( ) F2M/FTM Terminate
( ) Refuses to Answer Terminate
Are you of Hispanic or Latino origin or descent, such as Mexican, Mexican-American, Central American, South American or Puerto Rican, Cuban, or other Spanish-Caribbean background?
( ) Yes Continue (and make sure to ask 4a)
( ) No Continue
( ) Don’t Know Continue
( ) Refuses to Answer Terminate
Now I am going to read you a list of categories. Which of the following categories best describe your race?
( ) American Indian or Alaska Native Skip to 10
( ) Asian Skip to 10
( ) Black or African-American Skip to 10
( ) Native Hawaiian or other Pacific Islander Skip to 10
( ) White Skip to 10
( ) Other: ____________ Skip to 10
( ) Refuses to Answer Terminate
Make sure to ask Hispanic/Latino respondents Q 4a
4a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?
( ) English Skip to 10
( ) Spanish Terminate
( ) Both English and Spanish Skip to 10
( ) Other Terminate
FEMALE GENDER ONLY
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
Are you of Hispanic or Latino origin or descent, such as Mexican, Mexican-American, Central American, South American or Puerto Rican, Cuban, or other Spanish-Caribbean background?
( ) Yes Continue (and make sure to ask 6a)
( ) No Continue
( ) Don’t Know Continue
( ) Refuses to Answer Terminate
Now I am going to read you a list of categories. Which of the following categories best describe your race?
( ) American Indian or Alaska Native Skip to 10
( ) Asian Skip to 10
( ) Black or African-American Skip to 10
( ) Native Hawaiian or other Pacific Islander Skip to 10
( ) White Skip to 10
( ) Other: ____________ Skip to 10
( ) Refuses to Answer Terminate
Make sure to ask Hispanic/Latino respondents Q 6a
6a. [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
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 or Homosexual Continue
( ) Other Terminate
MSM ONLY
Are you of Hispanic or Latino origin or descent, such as Mexican, Mexican-American, Central American, South American or Puerto Rican, Cuban, or other Spanish-Caribbean background?
( ) Yes Continue (and make sure to ask 8a)
( ) No Continue
( ) Don’t Know Continue
( ) Refuses to Answer Terminate
Now I am going to read you a list of categories. Which of the following categories best describe your race?
( ) American Indian or Alaska Native Skip to 10
( ) Asian Skip to 10
( ) Black or African-American Skip to 10
( ) Native Hawaiian or other Pacific Islander Skip to 10
( ) White Skip to 10
( ) Other: ____________ Skip to 10
( ) Refuses to Answer Terminate
Make sure to ask Hispanic/Latino respondents Q 8a
8a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?
( ) English Skip to 10
( ) Spanish Terminate
( ) Both English and Spanish Skip to 10
( ) Other Terminate
HETEROSEXUAL MALE ONLY
Are you of Hispanic or Latino origin or descent, such as Mexican, Mexican-American, Central American, South American or Puerto Rican, Cuban, or other Spanish-Caribbean background?
( ) Yes Continue (and make sure to ask 9a)
( ) No Continue
( ) Don’t Know Continue
( ) Refuses to Answer Terminate
Now I am going to read you a list of categories. Which of the following categories best describe your race?
( ) American Indian or Alaska Native Skip to 10
( ) Asian Skip to 10
( ) Black or African-American Skip to 10
( ) Native Hawaiian or other Pacific Islander Skip to 10
( ) White Skip to 10
( ) Other: ____________ Skip to 10
( ) Refuses to Answer Terminate
Make sure to ask Hispanic/Latino respondents Q 9a
9a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?
( ) English Continue
( ) Spanish Continue
( ) Both English and Spanish Continue with Spanish or English
( ) Other Terminate
FOR ALL GROUPS
OK, just a few more questions for our records.
Please tell me your age.
(Record actual age) ___________________
( ) Age 18 to 35 Continue
( ) Age 35+ (older than 35 years) Continue
( ) Don’t know/Refuse…………………………………………………………....Terminate
Recruit half above and half below age 35 for each audience.
Which best describes your total annual household income?
( ) Less than $X Continue
( ) More than $X Continue
( ) Don’t know/Refuse…………………………………………………………....Terminate
Recruit half above median income and half below median income for each audience in each location.
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
( ) Don’t know/Refuse…………………………………………………………....Terminate
Are you comfortable reading and reviewing materials in [English/Spanish]?
( ) Yes, English Continue in English
( ) Yes, Spanish Continue in Spanish
( ) Yes, English and Spanish Continue in English or Spanish
( ) No/Don’t know Thank and Terminate
Invitation and Informed Consent
Thank you for answering these initial questions.
[If eligible, give informed consent information. After informed consent process is completed, continue with the interview.]
Next we are going to show you [poster/banner ad/public service announcement], some designs for materials, and a few paragraphs of information.
Part 2- Research Questions
[Please note that the items that will be tested in these intercept interviews will be based on earlier research. Entire intercept, excluding screening, will not last longer than 15 minutes.]
Issue A: Low Content Material Review
Please take a minute to review this [item]. [Item will most likely be a poster]
How likely is it that [insert] would catch your attention?
Very unlikely Somewhat unlikely Neither likely nor unlikely Somewhat Likely Very likely
What parts of the [insert] captured your attention? Select all that apply.
Colors
Pictures
Graphics
Title / Headline
Content
Layout
Other:________________
Did anything strike you as distasteful or inappropriate?
Yes
No
Not sure
3a. [If yes] What? How could it be changed to make it more appropriate?
What do you think is the main message of this [item]?
Is this message for someone like you, or do you think it is intended for someone else?
Someone like me
Someone else
Not sure
5a. [If participant responds with “Someone else,” please give this open ended question. Do not allow participant to move on without a response.] Who is this message intended for?
Is [insert] trying to get the [reader/viewer/listener] to do something?
Yes
No
Not sure
6a. [If yes] What is it trying to get them to do?
What would you change to make it better or more appealing to you?
After viewing this, did you have any questions that the [insert] did not answer?
Yes No Not sure
8a. [If participant selects “Yes,” please give this open ended question. Do not allow participant to move on without a response.] What questions were left unanswered?
How would you rate this [item] on a scale from 1 to 10, where 1 means you don’t like it at all, and 10 means that you like it a lot?
Response: ________
Issue B: Heavy Content Review
I would like to show you a few paragraphs of content. Please take a moment to review these paragraphs. I would like you to:
Underline phrases or sentences you think are important.
Circle things that are not clear or you don’t understand.
X out things you think aren’t necessary.
Put an exclamation mark (!) by anything you find offensive or inappropriate.
What do you think is the main message of this paragraph? [Open ended. Once participant answers this question, do not allow them to go back and change it.]
This message was intended to say that [insert purpose of paragraph]. How well do you think this gets that message across?
Not at all well Somewhat well Very well
2a. [If participant responds with “Not at all well” or ”Somewhat well,” please give this open ended question. Do not allow participant to move on without a response.] What would you change to get this message across more clearly?
Are you likely to trust this information?
Yes
No
Not sure
3a. [If participant responds with “No,” please give this open ended question. Do not allow participant to move on without a response.] What could be done to make this information more trustworthy?
Issue C: Design Element Review
Now I would like you to look at some different designs for materials. [Exact number is still to be determined] Please look at these [insert number] different designs.
How would you rate this [item] on a scale from 1 to 10, where 1 means you don’t like it at all, and 10 means that you like it a lot?
Response: ________
Which headline do you prefer?
[Insert headlines]
Which images do you prefer?
[Insert images]
Which colors do you prefer?
[Insert colors]
Which design do you prefer overall?
[Insert designs]
5a. Why?
Issue D: Next Steps
After seeing this information, are you interested in going to a Web site to learn more about HIV vaccine research?
Yes
No
Not sure
Before [reading/seeing] these materials, do you think you would have been supportive of a family member who wanted to participate in research to find a vaccine to prevent HIV?
Yes
No
Not sure
(If no or not sure is entered) Please indicate why you wouldn’t support your family member if they were interested in participating in HIV vaccine research? Check all that apply.
( ) I don’t think it’s important
( ) I’d be worried about the side effects
( ) I’d be worried that my family member would get HIV
( ) I don’t trust the information
( ) I don’t trust the researchers
( ) I don’t support any type of research
( ) I don’t want people to suspect that anyone in my family is HIV-positive
( ) I don’t think the research will be successful
( ) Other: ____________________
Before [reading/seeing] these materials, do you think you would have been supportive of a friend who wanted to participate in research to find a vaccine to prevent HIV?
Yes
No
Not sure
(If no or not sure is entered) Please indicate why you wouldn’t support your friend if they were interested in participating in HIV vaccine research? Check all that apply.
( ) I don’t think it’s important
( ) I’d be worried about the side effects
( ) I’d be worried that my friend would get HIV
( ) I don’t trust the information
( ) I don’t trust the researchers
( ) I don’t support any type of research
( ) I don’t want people to suspect that anyone in my friend is HIV-positive
( ) I don’t think the research will be successful
( ) Other: ____________________
Now that you have [read/seen] these materials, has your opinion of HIV vaccine research changed?
Yes (Go to 4a)
No (Skip to 4b)
Don’t know/Not sure (Skip to 4b)
4a. How has your opinion of HIV vaccine research changed?
I have more positive attitudes
I have less positive attitudes
If more positive: What made you have more positive attitudes about HIV
vaccine research? (Continue to 4b)
If less positive: What made you have less positive attitudes about HIV
vaccine research? (Continue to 4b)
4b. Could any additional information make you more supportive of HIV vaccine research?
Yes
No
Don’t know/Not sure
If yes: What kind of information might make you more supportive of HIV v accine
research?
Thank you very much for your time. Your feedback has been helpful.
If you’d like more information about HIV vaccine research, please visit: http://bethegeneration.nih.gov.
Please take a brochure if you would like more information about this topic. [Allow respondent to take a brochure]
Appendix 2: Intercept
Interview Screener and Guide
| File Type | application/msword |
| File Title | Mini Supporting Statement |
| Author | aed-user |
| Last Modified By | Bonny Bloodgood |
| File Modified | 2010-06-17 |
| File Created | 2009-09-18 |