0920-0572 Attatchment 6 - FGPRScreener_1_13

OMB No. 0920-0572

Expiration 3/31/2018

Submission under

0920-0572 Health Message Testing System

Attachment 6: Screening Questions: Focus Groups with Male Partners of Pregnant Women in Puerto Rico

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 (0920-0572)

Screening Questions

Focus Groups with Male Partners of Pregnant Women in Puerto Rico

Introduction

Hello, my name is _______________ and I’m contacting you on behalf of Abt Associates, a private research organization, and the Centers for Disease Control and Prevention, the nation’s leading public health agency, dedicated to saving lives and protecting the health of Americans.

We are not selling any product. We are contacting men in your area to invite them to be part of small group discussions, or focus groups. The purpose of the focus groups is to get feedback on a health education initiative related to Zika virus.

If you are eligible and choose to participate in the focus group, you will receive $75 as a token of our appreciation for participating in the discussion.

To see if you are eligible to participate in the focus group, we need to ask you some personal questions. It is your choice to answer these questions. Your answers will be kept private. You can refuse to answer a question or stop at any time.

If you are not eligible and/or choose not to be part of the focus group, all responses you give me today will be destroyed and you will not be contacted again.

These questions will only take a few minutes. May I ask you the questions now?

(1) Yes

(0) No [END SCREENING QUESTIONS]

Procedures for Recording and Limiting Information

Only record information for the questions in the screener. If an informant reveals additional personal information, thank them for being helpful, but guide them back to the screener questions- “That is interesting to learn, but can I now ask you about. . .”

All questions should be asked, “screened out” instructions are for the recruiter’s reference only.

Sampling plan for focus groups with men in Puerto Rico [in-person]:

Target:         6 focus groups of 10 men each (n=60) to be conducted in 3 municipalities in Puerto Rico.  Below we present the sampling approach according to geographic location.

Focus Groups
Location	N
San Juan (2 groups)	20
Ponce (2 groups)	20
Mayaguez (2 groups)	20
Total	60

Eligibility criteria

• Age 18+ years

• Gender

• Men in a relationship with a pregnant partner

• Have not previously participated in any focus group, survey, interview, or other search about Zika

• Resides, works in or is able to travel to San Juan, Ponce or Mayaguez

Location:      Focus groups will be held in 3 municipalities in Puerto Rico

1. What language are you most comfortable with for this group discussion?

1. English

2. Spanish

3. Equally comfortable in English and Spanish

4. Other [screen out]

2. What is your age?

_________ [RECORD AGE; If under 18 years of age, screen out]

3. What is your gender?

1. Male [skip to 3a]

2. Female [screen out]

(99) Rather not say [screen out]

3a. [ASK IF RESPONSE TO 3 = MALE] Are you currently in a relationship?

1. Yes, with a man [screen out]

2. Yes, with a woman [skip to 3b]

3. No [screen out]

(88) Not sure [screen out]

(99) Rather not say [screen out]

3b. How would you describe this relationship?

(1) Married

(2) Not married but living together

(3) Committed, serious or long-term

(4) Casual relationship

(88) Not sure

(99) Rather not say

3c. Is your partner pregnant?

(1) Yes [skip to 3d]

(2) No [screen out]

3d. What pregnancy trimester is she currently in?

1. First trimester of pregnancy (first 3 months)

2. Second trimester of pregnancy (4-6 months)

3. Third trimester of pregnancy (7-9 months)

88. Not sure

(99) Rather not say

4. Do you currently have any children? I’m asking about children separate from your pregnant partner.

1. No

2. Yes __ If Yes: How many children do you have? _______________

   1. What age(s) in years?

   2. Child 1 age: _______________

   3. Child 2 age: _______________

   4. Child 3 age: _______________

   5. Child 4 age: _______________

   6. Child 5 age: _______________

   7. Child 6 age: _______________

   8. Child 7 age: _______________

   9. Child 8 age: _______________

5. In what zip code do you currently live? [ENTER FIVE DIGIT ZIP CODE]. _____

[SCREEN OUT IF ZIP CODE IS FROM OUTSIDE OF PUERTO RICO]

[SCREENING FOR FOCUS GROUPS TO BE CONDUCTED ONLINE OR IN-PERSON WILL HAVE MORE DETAIL]

6. Have you ever participated in a focus group discussion or an interview about Zika before?

1. Yes [screen out]

2. No

(88) Not sure [screen out]

[Note to screening staff: Ensure at least half (or majority) of participants are from the first three educational completion groups in the next question.]

7. What is the highest level of education you have completed?

1. Grade school

2. Less than high school graduate/some high school

3. High school graduate or completed GED

4. Some college or technical school

5. Received four-year college degree

6. Some post graduate studies

7. Received advanced degree

8. Other [SPECIFY]

8. What is your current job or employment status?

1. Employed for wages [skip to 8a]

2. Self-employed [skip to 8a]

3. Out of work and looking for work

4. Out of work but not currently looking for work

5. A homemaker

6. A student

7. Military

8. Retired

9. Unable to work

(88) Not sure

(99) Rather not say

a. [Note to screening staff: If response to employment question 10 is 1 or 2, ask the following:] Do you work for any of the following types of employers?

1. Government agency [screen out]

2. Public health or health care agency [screen out]

3. Marketing firm/agency [screen out]

[Note to screening staff: Ensure at least half (or majority) of participants are from the first three income groups in the next question.]

9. Which best describes your total household income during the past year?

1. Less than $20,000

2. $20,001 to $30,000

3. $30,001 to $40,000

4. $40,001 to $50,000

5. $50,001 or more

9. Prefer not to answer

10. Please indicate your ethnic background:

1. Hispanic or Latino [skip to 10a]

2. Not Hispanic or Latino

10a. In what country or territory were you born?

1. United States

2. Puerto Rico

3. Mexico

4. Cuba

5. Colombia

6. Other [SPECIFY:_______________]

(99) Prefer not to answer

11. Please indicate your race (You may select one or more).

1. White/Caucasian

2. Black or African-American

3. American Indian or Alaska Native

4. Native Hawaiian or Other Pacific Islander

5. Asian

If ineligible – skip to “Closing for ineligible participant)

If eligible –

Invitation:

[TEXT BELOW TO BE ADAPTED AS NEEDED.]

Based on your answers, you are eligible to participate in the focus group (or group discussion). As I mentioned earlier, we are talking to men about Zika and we would like to include your opinions. We would like to invite you to take part in focus group with other men to provide feedback on materials for a health education initiative related to Zika virus. The focus group will last about 90 minutes. You will not be asked to buy anything. You will / will not be contacted at a later date to remind you of the focus group. Any information that you provide to us will be kept private. We're simply interested in your opinions.

12. For participating in the group discussion, you will receive $75 as a token of our appreciation. Will you be able to join us for this group discussion?

(1) Yes [SKIP TO 12 a]

(0) No (Refuse to participate) [THANK AND END]

Closing for Ineligible Participants:

“Thank you for answering all of my questions. You are not eligible to take part in this focus group. There are many possible reasons why people are not eligible. We value your interest. Thank you for being willing to help us.”

[Do not provide reasons for ineligibility.]

12 a. [IF “YES” TO INVITATION, READ THE FOLLOWING STATEMENTS…]

“We will be audio recording the focus group and some project staff from Abt and CDC may be observing the interview. We may also use a live video or audio stream so project staff from Abt and CDC can observe from a computer or telephone in another location.” In order to participate in the focus group, you will need to agree to being audiotaped and allowing up to 3 staff from the Abt and CDC team to observe. We take your privacy very seriously. Your information will not be shared with anyone other than the research team and all tapes will be destroyed at the end of the project. You may choose to use a fake name during the focus group. Regardless, we will never link your name with any comment you make in the focus group in any report that we write.

You will be asked to respond to visual and reading materials, which are written at the [INSERT] grade-reading level. If you need to wear glasses either for reading or watching TV, please bring them with you.

Also, we need to let you know that there will not be any childcare provided at the facility, so please make the appropriate childcare arrangements if you have children.

In order for us to send you a reminder email with directions to the focus group facility and to call to remind you of your appointment time, I need to ask for your contact information. We will destroy this information after the focus group is over.”

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