Attachment A:
Recruitment and Consent Materials
VOICEMAIL SCRIPT: Hello, my name is [RECRUITER FIRST AND LAST NAME]. I'm calling on behalf of the American Institutes for Research (AIR), a non-profit research organization. We are calling to invite you to take part in community discussion groups about health care quality. Please call {INSERT PHONE NUMBER} at your convenience.
INTRO WHEN PERSON ANSWERS THE PHONE
Hello, may I please speak with [FIRST AND LAST NAME]? My name is [RECRUITER FIRST AND LAST NAME]; and I'm calling on behalf of the American Institutes for Research (AIR), a non-profit research organization.
IF RESPONDENT NOT AVAILABLE, EITHER:
DETERMINE A GOOD TIME TO CALL BACK OR
LEAVE MESSAGE ON ANSWERING MACHINE
IF RESPONDENT IS AVAILABLE, INTRODUCE SELF AND REASON FOR CALLING.
I’m calling today to tell you about an exciting opportunity to be involved in discussion groups taking place in your community about health care quality. Leading health care experts and government decision-makers want to hear from members of the community like you. These groups are a chance for you to share your opinions.
Four different types of discussion groups will be taking place in your community at { place }. If you are interested in voicing your opinion about important health care issues, and you meet study requirements, we will invite you to participate in one of these groups this summer or fall. You would be paid for taking part.
May I ask you a few questions? IF YES, CONTINUE TO Q1. IF NO, THANK & END (END SCRIPT B).
IF NEEDED, EXPLAIN FURTHER: Because we want to include people who are a mix of different backgrounds and experiences, I need to ask you a few questions to see if you qualify.
ELIGIBILTY CRITERIA QUESTIONS
Q1. Part of this project involves taking surveys online. Would you be able to take them online?
YES
NO END SCRIPT A
Q2. How comfortable do you feel completing a survey online?
Not very comfortable, END SCRIPT A
Somewhat comfortable
Very comfortable
Q3. How old were you on your last birthday? (NONE UNDER 18, RECRUIT MIX)
________________
IF UNDER 18, THANK & END (END SCRIPT A)
Q4. Are you or have you ever been employed as a practicing physician, nurse practitioner, registered nurse (RN), licensed-practical nurse (LPN), or physician’s assistant?
YES END SCRIPT A
NO
Q5. Have you had any other job in the healthcare field?
YES (write in OCCUPATION) ____________________
NO
Q6. What is your gender? (RECRUIT MIX, SEE TABLE 1)
MALE
FEMALE
Q7. Are you comfortable reading and having conversations in English?
YES
NO, THANK & END (END SCRIPT A)
Q8. What is the highest grade or level of school you have completed? (RECRUIT MIX; 32% high school grad or less)
Less than high school graduate
High school graduate
GED
Technical or vocational school or certificate program
Associate’s degree (2-year college graduate)
1 or more years of college but didn’t graduate
4-year college graduate
More than 4-year college graduate
Q9. Are you of Hispanic, Latino, or Spanish background?
YES
NO
Q10. How would you describe your race? (SEE TABLE 1, PRIORITY POPULATION QUOTAS)
CHECK ALL THAT APPLY
American Indian or Alaskan Native
Asian or Pacific Islander
Black or African-American
White
Another race (write in) ____________________
Q11. Do you speak a language other than English at home?
YES
NO SKIP TO Q10
Q12. What is this language? (RECRUIT 19 BILINGUAL HISPANICS)
SPANISH
ANOTHER LANGUAGE
Q13. Finally, if you agree to take part in the discussion groups, we will need to provide your email address and phone number to AIR so that they can contact you to provide the details about taking part in the groups. Will that be okay with you?
YES
NO END SCRIPT A
MAYBE, BUT I WOULD LIKE MORE INFORMATION BEFORE DECIDING Provide names, phone numbers, and website where participants can get more information. Make arrangements to call back.
STEP 2, IF INDIVIDUAL MEETS ELIBILITY CRITERIA:
Thank you for answering all of my questions. It looks like you’re eligible to participate in the community discussion! Four different types of discussion groups will be held in your community this summer and fall. Some groups are longer, some are shorter, some happen online, though most of them are in person. All the groups will give participants the opportunity to discuss important health care issues with people from your community.
I’m going to read you a description of each type of group and ask you to tell me which ones you’d be interested in. Then we’ll go through the dates and times of the groups. Once we see your availability, AIR will assign you either to one of the discussion groups or a materials only group. The assignment will be made “at random,” which means by chance, like flipping a coin. If you are assigned to the materials only group, we will ask you to read educational materials at home, but not take part in the discussion groups. Everyone assigned to a group will be asked to complete surveys before and after the groups take place. If your preferred groups are full, you may not be selected to take part at this time.
You may want to get your calendar to check your availability.
CHECK IF INTERESTED |
DISCUSSION GROUP DESCRIPTION |
CODE |
DATES AND TIMES |
CHECK IF AVAILABLE |
□
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For Brief Citizens’ Deliberation (BC), you will:
|
110 |
Tuesday, Aug. 14 from 12:30-3:00pm CT |
□ |
120 |
Tuesday, Aug. 14 from 5:30-8:00pm CT |
□ |
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130 |
Wednesday, Aug. 15 from 12:30-3:00pm CT |
□ |
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140 |
Wednesday, Aug. 15 from 5:30-8:00pm CT |
□ |
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150 |
Thursday, Aug. 16 from 12:30-3:00pm CT |
□ |
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160 |
Thursday, Aug. 16 from 5:30-8:00pm CT |
□ |
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□ |
For Citizens’ Panel (CP), you will:
|
210 |
Friday, Aug. 17 from 9:00am-5:00pm CT, & Saturday, Aug. 18 from 9:00am-5:00pm CT & Sunday, Aug. 19 from 9:00am-1:00pm CT
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□ |
□ |
For Community Deliberation (CD), you will: |
310 |
Tuesday, Aug. 14 from 12:00-3:00pm CT & |
□ |
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Tuesday, Aug. 21 from 12:00-3:00pm CT |
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320 |
Tuesday, Aug. 14 from 6:00-9:00pm CT & |
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Tuesday, Aug. 21 from 6:00-9:00pm CT |
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330 |
Wednesday, Aug. 15 from 12:00-3:00pm CT & |
□ |
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Wednesday, Aug. 22 from 12:00-3:00pm CT |
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340 |
Wednesday, Aug. 15 from 6:00-9:00pm CT & |
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Wednesday, Aug. 22 from 6:00-9:00pm CT |
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350 |
Thursday, Aug. 16 from 12:00-3:00pm CT & Thursday, Aug. 23 from 12:00-3:00pm CT |
□ |
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360 |
Thursday, Aug. 16 from 6:00-9:00pm CT & Thursday, Aug. 23 from 6:00-9:00pm CT |
□ |
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□ |
For Online Deliberative Polling® (ODP), you will: |
411 |
Tuesday, Oct. 2 from 6:00-7:15pm CT & |
□ |
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Tuesday, Oct. 9 from 6:00-7:15pm CT & |
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Tuesday, Oct. 16 from 6:00-7:15pm CT & |
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Tuesday, Oct 23 from 6:00-7:15pm CT |
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412 |
Tuesday, Oct. 2 from 7:00-8:15pm CT & |
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Tuesday, Oct. 9 from 7:00-8:15pm CT & |
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Tuesday, Oct. 16 from 7:00-8:15pm CT & |
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Tuesday, Oct 23 from 7:00-8:15pm CT |
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413 |
Tuesday, Oct. 2 from 8:00-9:15pm CT & |
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Tuesday, Oct. 9 from 8:00-9:15pm CT & |
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Tuesday, Oct. 16 from 8:00-9:15pm CT & |
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Tuesday, Oct 23 from 8:00-9:15pm CT
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414 |
Tuesday, Oct. 2 from 9:00-10:15pm CT & |
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Tuesday, Oct. 9 from 9:00-10:15pm CT & |
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Tuesday, Oct. 16 from 9:00-10:15pm CT & |
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Tuesday, Oct CT from 9:00-10:15pm ET |
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421 |
Wednesday, Oct. 3 from 6:00-7:15pm CT & |
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Wednesday, Oct. 10 from 6:00-7:15pm CT & |
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Wednesday, Oct. 17 from 6:00-7:15pm CT & |
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Wednesday, Oct 24 from 6:00-7:15pm CT |
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422 |
Wednesday, Oct. 3 from 7:00-8:15pm CT & |
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Wednesday, Oct. 10 from 7:00-8:15pm CT & |
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Wednesday, Oct. 17 from 7:00-8:15pm CT & |
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Wednesday, Oct 24 from 7:00-8:15pm CT |
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423 |
Wednesday, Oct. 3 from 8:00-9:15pm CT & |
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Wednesday, Oct. 10 from 8:00-9:15pm CT & |
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Wednesday, Oct. 17 from 8:00-9:15pm CT & |
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Wednesday, Oct 24 from 8:00-9:15pm CT |
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424 |
Wednesday, Oct. 3 from 9:00-10:15pm CT & |
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Wednesday, Oct. 10 from 9:00-10:15pm CT & |
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Wednesday, Oct. 17 from 9:00-10:15pm CT & |
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Wednesday, Oct 24 from 9:00-10:15pm CT |
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431 |
Thursday, Oct. 4 from 6:00-7:15pm CT & |
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Wednesday, Oct. 11 from 6:00-7:15pm CT & |
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Wednesday, Oct. 18 from 6:00-7:15pm CT & |
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Wednesday, Oct 25 from 6:00-7:15pm CT |
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432 |
Thursday, Oct. 4 from 7:00-8:15pm CT & |
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Wednesday, Oct. 11 from 7:00-8:15pm CT & |
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Wednesday, Oct. 18 from 7:00-8:15pm CT & |
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Wednesday, Oct 25 from 7:00-8:15pm CT |
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433 |
Thursday, Oct. 4 from 8:00-9:15pm CT & |
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Wednesday, Oct. 11 from 8:00-9:15pm CT & |
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Wednesday, Oct. 18 from 8:00-9:15pm CT & |
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Wednesday, Oct 25 from 8:00-9:15pm CT |
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434 |
Thursday, Oct. 4 from 9:00-10:15pm CT & |
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Wednesday, Oct. 11 from 9:00-10:15pm CT & |
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Wednesday, Oct. 18 from 9:00-10:15pm CT & |
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Wednesday, Oct 25 from 9:00-10:15pm CT |
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Materials Only Group |
100 |
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□ |
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If you are assigned to the group to receive materials to read at home, you’ll be paid $75 for reading the materials accessible online and taking 2 surveys. |
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NOTE: RECRUITED PARTICPANTS MUST AGREE TO PARTICIPATE IN AT LEAST 2 GROUPS. IF THE PERSON ONLY SELECTS ONE GROUP, SAY:
AIR is interested in learning the types of groups that work better and are preferred by more people. Because they’ll be comparing the groups to each other, in order to be included you’ll need to select 2 or more types of discussion groups.
STEP 3, AFTER 2 GROUPS ARE SELECTED:
Thank you for indicating your availability. Next, you will receive an email with a link to complete an online survey. Please complete your survey as soon as you get it. This email will come from the SNAP Survey address: {insert}. Please add this email address to your email contact list to prevent this email from being blocked by your email account’s SPAM blocker. After you complete the survey, we will call you letting you know if you are selected for a group, as well as the dates, times, locations, and other details.
Here are a few more details:
|
INITIALS OF RECRUITER |
The project is funded by the Agency for Health Care Research and Quality (AHRQ), which is part of the U.S. Department of Health and Human Services. |
_______ |
The discussion groups are part of a research project to get input from people about improving health care quality and to learn more about the best ways to get public input on important health care issues. There are no known risks to taking part in this type of study. Although there are no direct benefits to participants, other than payment for your time, what we learn will help policymakers make more informed decisions on health care policy issues, which could improve the quality of health care. |
_______ |
The information you shared with me today, as well as any information you provide on the surveys or in the groups will not be shared with anyone outside the AIR project team. Your name will not be used in any report or publication. |
_______ |
The discussion groups will be video and audio-taped in order to capture all information. Only researchers from this project will have access to the tapes. |
_______ |
If you agree to take part, I need to verify the spelling of your name, mailing address, and email address. We will not use this information for any purpose outside of this study. CONFIRM RESPONDENT’S INFORMATION.
Name:______________________________________Telephone:_______________________
Address:_____________________________________________________________________
City, State:____________________________________________Zip:____________________
Email:________________________________________________
IF NO EMAIL ADDRESS, ASK: Would you be willing to create a free email account through Gmail or Yahoo for this project?
Also, please let me confirm that I have all your correct phone numbers so that we may call and confirm with you. CONFIRM RESPONDENT’S INFORMATION.
Home phone: ___________________________ Other Phone: __________________________
If you have any questions or find that you can’t attend, please call us right away at {insert phone number}. Thank you for your time and for agreeing to help.
If you have questions or would like more information about this project, contact Kirsten Firminger at {AHRQcommunityforum@air.org or call toll free at 1-800-555-5555}.
If you have concerns or questions about your rights as a participant, contact the Project Director, Kristin Carman at 1-800-555-5555 or the Chair of AIR’s Institutional Review Board at IRBChair@air.org, or toll free at 1-800-634-0797.
Recruitment firms to use standard script for non-eligible participants.
END SCRIPT B (GENERIC THANK AND END):
I appreciate your taking the time to speak with me and I hope you have a good day.
The project is sponsored by the Agency for Health Care Research and Quality (AHRQ) which is part of the U.S. Department of Health and Human Services. AHRQ’s mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. For information about the Agency for Health Care Research and Quality, go to AHRQ’s website: http://www.ahrq.gov
Dear (first name) (last name),
Thank you for agreeing to take part in the Community Forum project! Community Forum is a research project to get input from people about improving health care quality and to learn more about the best ways to get public input on important health care issues.
Please click the link below and complete your survey. It is very important that you complete the survey as soon as possible. Please take a survey now or in the next 24 hours as the first step in this project.
The survey asks about your opinions on healthcare topics and asks some questions about you. It will take about 30 minutes to complete.
We will not share the information from your survey with anyone outside the project team. We will not use your name in any reports or publications. There are no known risks or direct benefits for taking part in the Community Forum project. Your input in this project will help policymakers make more informed decisions on health care policy issues, which could improve the quality of health care.
Please call [800-xxx-xxxx] or email CommunityForum@air.org if you have questions or concerns about this survey or the project. We look forward to your participation.
To take the survey, please click this (LINK).
Thank you,
Kirsten Firminger
American Institutes for Research
(This is a project funded by the Agency for Healthcare Research and Quality, a federal government agency, and led by the American Institutes for Research, a non-profit research organization.)
Dear (first name) (last name),
Thank you for agreeing to take part in the Community Forum project! Community Forum is a research project to get input from people about improving health care quality and to learn more about the best ways to get public input on important health care issues.
This is a reminder to complete your survey as soon as possible. Your opinions about health care are very important to us.
To take the survey, please click this (LINK).
The survey asks about your opinions on healthcare topics and asks some questions about you. It will take about 30 minutes to complete.
We will not share the information from your survey with anyone outside the project team. We will not use your name in any reports or publications. There are no known risks for taking part in the Community Forum project. Your input in this project will help policymakers make more informed decisions on health care policy issues, which could improve the quality of health care.
Please call [800-xxx-xxxx or email CommunityForum@air.org if you have questions or concerns about this survey or the project. We look forward to your participation.
Thank you,
Kirsten Firminger
American Institutes for Research
(This is a project funded by the Agency for Healthcare Research and Quality, a federal government agency, and led by the American Institutes for Research, a non-profit research organization.)
Dear (first name) (last name),
Thank you taking part in the Community Forum project!
The final step of this project is to complete this survey. Please be sure to complete this survey now or in the next 24 hours. After you complete the survey, you will be mailed your incentive payment within 4 weeks.
To take the survey, please click this (LINK).
Like the survey you received at the beginning of the project, this survey asks about your opinions on healthcare topics. It will take about 30 minutes to complete.
Your input in this project will help policymakers make more informed decisions on health care policy issues, which could ultimately improve the quality of health care. We will not share the information from your survey with anyone outside the project team. We will not use your name in any reports or publications.
Please call 800-xxx-xxxx or email CommunityForum@air.org if you have questions or concerns about this survey or the project.
Thank you!
[name]
American Institutes for Research
(This is a project funded by the Agency for Healthcare Research and Quality, a federal government agency, and led by the American Institutes for Research, a non-profit research organization.)
Dear (first name) (last name),
Thank you taking part in the Community Forum project! Your input in the project will help policymakers make more informed decisions on health care policy issues, which could ultimately improve the quality of health care.
This is a reminder to complete your survey as soon as possible. After you complete the survey, you will be mailed your incentive payment within 4 weeks.
To take the survey, please click this (LINK).
Like the survey you at the beginning of the project, this survey asks about your opinions on healthcare topics. It will take about 30 minutes to complete. We will not share the information from your survey with anyone outside the project team. We will not use your name in any reports or publications.
Please call 800-xxx-xxxx or email CommunityForum@air.org if you have questions or concerns about this survey or the project.
Thank you!
Kirsten Firminger
American Institutes for Research
(This is a project funded by the Agency for Healthcare Research and Quality, a federal government agency, and led by the American Institutes for Research, a non-profit research organization.)
Community
Forum_ Recruitment Screener Chicago
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Amy Windham |
| File Modified | 0000-00-00 |
| File Created | 2021-01-31 |