Request for Approval - Screener

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1027)

TITLE OF INFORMATION COLLECTION: Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community – Screener

PURPOSE: In previous work, a guide to sexual health preventive services (i.e., Take Charge of Your Sexual Health: What you need to know about preventive services [hereafter, the Guide]) was developed, tested, and disseminated widely with the goal of helping all people in the U.S. achieve learn more about the preventive health services they should be receiving for optimum sexual health. This guide was written in English and, though disseminated to a broad array of population segments, was not calibrated to address a primarily Spanish-speaking audience. To help ensure that the Guide is clear, relevant, and appealing to the target audience of Spanish-language dominant Hispanics, it is important to conduct pre-testing to explore overall effectiveness of the translation of this information from English. The primary objective of this project is to test the clarity, relevance, and appeal of the Guide among Spanish-language dominant Americans. As part of this larger project to pre-test the Guide with the Hispanic Community, potential participants need to be screened for eligibility to participate in one of a series of focus groups (Att1). To that end, a screening instrument will be used to evaluate the eligibility of potential participants, with collected information compared to pre-determined inclusion and exclusion criteria. Those potential participants which align with pre-determined inclusion and exclusion criteria will form a pool of potential participants. These eligible potential participants will then be asked to participate in one of a series of focus groups.

Research instruments include; Att1 Screener, Att2 Spanish Sexual Health Guide, Att3 Focus Group Moderator Guide, Att4 English Sexual Health Guide, Att5 English Spanish Discussion Guide, and Att6 Comparison English/ Spanish Guide.

Two professional, Spanish-speaking moderators will lead the group discussions based on the discussion guide (See Att5 English Spanish Discussion Guide). A female moderator will lead the groups with women, and a male moderator will lead the groups with men. The groups will be conducted in Spanish. Prior to the small group discussions, the participants will be given a quiet place to read the Spanish-language version of the Guide on their own (See Att2 Spanish Sexual Health Guide that participants will read). As they are reading, the participants will be asked to highlight any areas that stand out to them or that are confusing.

A few study staff may observers the groups, and the discussion groups will be audio taped, although the observers will not know the participants full name or contact information. The audiotapes will be kept in a locked cabinet. No one outside of the project will listen to the recordings. The names of participants will not be included in the recording or report. The recordings will be destroyed within 12 months from date of pre-testing. The participants’ names and contact information will be kept in a sealed envelope in a secure location and will be destroyed within 12 months from date of pre-testing.

DESCRIPTION OF RESPONDENTS: Respondents will be recruited by outreach to and referrals from residents of San Diego, CA, who have already been recruited through phone calls or online methods to be included in a database of people who are willing to participate in public opinion and market research projects.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[ ] Focus Group [X] Other: Eligibility Screening

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Penny S. Loosier_______________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [X ] Yes [ ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ X ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours
Individuals or Households	20	15 minutes	5
Totals			5 hours

FEDERAL COST: The estimated annual cost to the Federal government is _$4846.00____

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Sampling: Respondents will be recruited by outreach to and referrals from residents of San Diego, CA, who have already been recruited through phone calls or online methods to be included in a database of people who are willing to participate in public opinion and market research projects.

Individuals will be contacted by phone, and screened for eligibility and interest in this particular project by professional recruiters using a Spanish-language screening questionnaire. Participants who meet eligibility criteria and who agree to participate will be invited to join a discussion group session. Inclusion and exclusion criteria are as follows:

Participant inclusion criteria:

General inclusion criteria for all participants:

• All participants will speak Spanish at home, watch and listen to Spanish-language entertainment.

• When completing official forms, they will choose to use Spanish-language forms, rather than English-language forms.

• Some or all individuals will be Internet users and users of Spanish-language websites.

Specifically, four groups will be conducted as follows:

• One group with women (ages 18-39) who were born and/or raised in Mexico or to Mexican parents.

• One group with women (ages 18-39) who were born and/or raised in Central America or to parents from this region.

• One group with men (ages 18-39) who were born and/or raised in Mexico or to Mexican parents.

• One group with men (ages 18-39) who were born and/or raised in Central American or to parents from this region.

Participant exclusion criteria: Participants may not be under the age of 18. Since the sexual health needs and issues of younger adolescents would differ markedly from those of young adult and adult participants, their inclusion would not be advisable. Participants may not be over the age of 39. The 18-39 year-old age group was selected as the study population since this age group bears the largest burden of poor sexual health, many of the preventive services are recommended for them, and resources for this study are limited. Participants may not work in the following industries: advertising or public relations, market research, news media, healthcare, or public health. They may not be attending school or training for the health care or public health field.

Data management: Respondents will be drawn from a pool of individuals who have already been recruited through phone calls or online methods to be included in a database of people who are willing to participate in public opinion and market research projects hosted by Michael’s Opinion Research. Michael’s Opinion Research will not release any of the information collected via the screener to any project staff who are not employed by Michael’s Opinion Research. Upon agreeing to be included in this database, respondents consent to having their names, telephone numbers, and addresses stored for the duration of their agreed upon period of overall participation. Respondents can request that their name be removed from this database at any time. Information gathered during the screener will be used only to determine eligibility to participate in a focus group (Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community). Eligible respondents will be asked if they wish to participate. Regardless of eligibility or agreement/disagreement to participate, no additional data will be added to their profile in the database. No new PII is created via implementation of the screener.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ X ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

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