Form
Approved
OMB
No. 0920-0572
Expiration
Date: 2/28/2015
Message Testing for CDC’s Division of Community Health with the General Public and Engaged Public
Recruitment:
Recruit 10 general public members for 8 participants to show for each focus group (total = 60 participants per market (4))
Recruit 4 for 3 to show for each engaged public triad (total= 12 participants per market (4))
Incentive: $50 per participant
Duration:
1.5 hours or less per general public focus group + 10 minutes for screening
60 minutes or less per engaged public triad + 10 minutes for screening
Introduction
Hello, my name is ________ and I am calling from __________________, a marketing research firm in the ________________ area. I know you receive a lot of telephone calls from telemarketers, but I assure you, this is not a sales call. I am calling today to see if you might qualify to participate in a discussion group. Everyone who is eligible and participates will receive $50 to show appreciation for your participation. The research study is sponsored by the Centers for Disease Control and Prevention, also known as the CDC. We are interested in hearing the opinions of people in our community on several topics.
May I please ask you a few questions? Thank you.
Screens
1b. Do you, or does any member of your household or immediate family work for:
( ) A market research company Terminate
( ) An advertising agency or public relations firm Terminate
( ) The media (TV/radio/newspapers/magazines) Terminate
( ) As a healthcare professional
(doctor, nurse, pharmacist, dietician, etc.)…………………………..…... Continue if not self
Public
Reporting Burden Statement
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 Information Collection Review Office, 1600 Clifton Road
NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0572).
11c. Some local television and radio news programs include special segments of the newscasts that focus on health issues. In the past 12 months, have you watched or listened to health segments on the local news?
( ) Yes …………………………………….. …Continue [Skip to Q26d]
( ) No Continue
10c. Some newspapers or general magazines publish a special section that focuses on health. In the past 12 months, have you read health sections of the newspaper or of a general magazine?
( ) Yes Continue [Skip to Q26d]
( ) No Continue to Q12c
12c. Some people notice information about health on the Internet, even when they are not trying to find out about a health concern they have or someone in the family may have. Have you read such health information on the Internet in the past 12 months?
( ) Yes Continue [Skip to Q26d]
( ) No Continue to Q1c
1c. Have you ever looked for health information from any source?
( ) Yes Continue
( ) No Terminate
7c. Think about the most recent time you looked up information on [health] from any source. About how long ago was that?
( ) Days ago Continue
( ) Weeks ago Continue
( ) Months ago Continue
( ) Years ago Terminate
( ) Never Terminate
26d. Do you see yourself doing this…[e.g., attend a public meeting on town or school affairs, write a letter to the paper] or something like it? Why or why not? [If they say “yes” to at least 2 behaviors, continue screening as “engaged public;” otherwise continue as “general public”]
□ General public [continue to Q6a(1)]
□ Engaged public [continue to Q6a(2)]
6a(1). Please indicate your race or ethnic background. Are you?
Ethnicity:
( ) 1. Hispanic or Latino Continue
( ) 2. Not Hispanic or Latino Continue
SELECT ONE OR MORE.
Race:
( ) 1. White Continue ( ) 2. Black or African-American Continue
( ) 3. American Indian or Alaska Native Terminate
( ) 4. Native Hawaiian or Other Pacific Islander Terminate
( ) 5. Asian Terminate
[Focus Groups: Recruit by race/ethnicity according to table in the HMTS expedited review form]
6a(2). Please indicate your race or ethnic background. Are you?
Ethnicity:
( ) 1. Hispanic or Latino Continue
( ) 2. Not Hispanic or Latino Continue
SELECT ONE OR MORE.
Race:
( ) 1. White Continue
( ) 2. Black or African-American Continue
( ) 3. American Indian or Alaska Native Continue
( ) 4. Native Hawaiian or Other Pacific Islander Continue
( ) 5. Asian Continue
[Triads: Recruit a mix]
42a. Most of the discussion will involve speaking and reading in English. Are you comfortable with speaking and reading in English?
( ) Yes Continue
( ) No Terminate
4a. What is the highest level of education you have completed?
( ) Grade school Terminate
( ) Less than high school graduate/some high school Terminate
( ) High school graduate or completed GED Continue
( ) Some college or technical school Continue
( ) Received four-year college degree Continue
( ) Some post graduate studies Terminate
( ) Received advanced degree Terminate
( ) Other: _____________________ …………………………………………….. Terminate
[Focus Groups: Recruit a mix]
25a. What is your age? _______________ (record age) [Terminate if not age 25 to 64]
[Focus Groups: Recruit a mix of ages between 25 to 64]
13a. Which of the following categories best describe your total, annual household income?
( ) Under $20,000/year Terminate
( ) $20,001 - $30,000/year Continue
( ) $30,001 - $40,000/year Continue
( ) $40,001 - $50,000/year Continue
( ) $50,001 - $60,000/year Continue
( ) $60,001 - $80,000/year Continue
( ) $80,001 - $100,000/year Continue
( ) Over $100,000/year Continue
[Focus Groups: Limit recruitment of participants in each focus group to no more than 5 with yearly household incomes in the $20,001 to $50,000 range and no more than 5 in the $50,001+ range (with no more than 2 in the +$100,000 range)]
10a. What is your current occupational status? Would you say…?
( ) Employed full time Continue
( ) Employed part time Continue
( ) Unemployed Continue
( ) Homemaker Continue
( ) Student Continue
( ) Retired, or Continue
( ) Disabled Continue
( ) Other: ______________ Continue
( ) Don’t Know/Not Sure (DO NOT READ) Continue
( ) Refused (DO NOT READ) Continue
1a.
Gender
[Do
not ask]
( ) Male Continue
( ) Female Continue
[Recruit about half male and half female for focus groups and triads]
12a. What is your marital status?
( ) Married Continue
( ) Unmarried living with a partner Continue
( ) Divorced Continue
( ) Widowed Continue
( ) Separated, or Continue
( ) Single, never been married Continue
( ) Don’t Know/Not Sure (DO NOT READ) Continue
( ) Refused (DO NOT READ) Continue
[Focus Groups: Recruit a mix]
24a. Are you the parent or guardian of a [boy/girl], ages [0-18] years?
( ) Yes Continue
( ) No Continue
[Focus Groups: Recruit a mix]
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(s) available at [Time(s) available] at [Focus Group: Indicate location and address; Triads: Describe remote process]. You will join up to [Focus groups: 9 other people; Triads: 3 other people] and a moderator. The group will meet for about [Focus groups: 90 minutes; Triads: 60 minutes]. To show appreciation for your participation you will get $50.
Scheduled Date: _____________________ Time: ______________________
[For engaged public, confirm whether they will have a computer with reliable high-speed internet and a reliable phone connection to take part in the discussion remotely, and whether they feel comfortable doing this. If not, put on HOLD as potential focus group participant.]
If you wear reading glasses or use a hearing aid, please remember to have them with you for the discussion.
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 letter with directions and give you a reminder call the day of the group.
FULL NAME ____________________________________________
ADDRESS ____________________________________________
____________________________________________
E-MAIL ____________________________________________
CELL PHONE ____________________________________________
HOME PHONE____________________________________________
WORK PHONE____________________________________________
I must let you know that we do consider this to be a firm commitment on your part and we really expect to see you then. We are under obligation to our client to seat the correct number of participants in each group, so if you discover that you must cancel, please inform us at once so that we can replace you.
[For in-person discussion groups say: Please bring the confirmation letter with you to the session, as well as your photo ID.]
We will call/email you a day or two before your session just to confirm everything. Thank you again for your time and we will see you at the group.
General
Public and Engaged Public Discussion Groups Recruitment Screener
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | AED - Centers for Disease Control and Prevention |
Author | tlehman |
File Modified | 0000-00-00 |
File Created | 2021-01-31 |