HMTS Expedited Review Form

Health Message Testing System Expedited Review Form
1. Title of Study: (Please append screener and questionnaire)

Older Adult Mobility Planning Brochure

2. Study Population: (Discuss study population and explain how they will be selected/recruited.)

Respondents will be community-dwelling, English-speaking U.S. residents aged 60 to 74 years old living
independently with good or very good self-rated mobility.

Respondent characteristics:
Number of subject: 36

Number of males:

~18

Age range: 60-74

Number of females: ~18

Racial/ethnic composition: White non-Hispanic, Black non-Hispanic, Hispanic, Asian-Pacific
Special group status: (e.g., risk group, health care providers)
Type of group(s):
Geographic location(s): St Louis, MO; Atlanta, GA

3. Incentives: (State what incentive will be offered and justify proposed incentives to be used in study.)

Each focus group participant will receive $75 in cash for participation. Based on references consulted and
past experience with this age group, providing incentives to respondents is necessary to successfully
recruit individuals for qualitative projects conducted in person. See Attachment B.

4. Study method: (Please check one below)
Central location intercept interview:
Online Interview:
Telephone interview:
Other (describe):

Focus group:
Individual in-depth interview (cognitive interview):

(CATI used: yes or no): No

5. Purpose of the overall communication effort into which this health message(s) will fit:
(Please provide 2-3 sentences below.)

The purpose of this request is to refine message concepts and to test informative materials for clarity,
appeal, and usability of the MyMobility brochure, as well as the best ways for CDC to disseminate the
brochure. This information will be collected through a series of six focus groups, CDC will use findings
to refine the effectiveness of the messages for the intended audiences (Att B.)

6. Category of time sensitivity: (Please check one below)
Health emergency:
Time-limited audience access:
Press coverage correction:
Time-limited congressional/administrative mandate:
Trend Tracking
Ineffective existing materials due to historical event/social trends:
7. Describe nature of time sensitivity: (Please provide 2-3 sentences below.)
The Mobility Planning Tool is slated for release in 2018. CDC needs information on the usability of and
satisfaction with the tool to refine prior to dissemination. In addition, CDC needs information on the best
communication channels to use with this group for dissemination.

8. Number of burden hours requested: 106

BURDEN HOURS
Category of Respondent

No. of
Participation
Respondents Time

Burden

Individuals - Recruitment/Screening Phone Call (Att C - Participant Screener)

300

5/60

25

Individuals - Confirmatory Letter (Att E) and Focus Group Moderator Guide (Att F)

36

2 and 15/60

81

Totals
9. Are you using questions from the approved question bank?

106

No

If yes, please list the item number(s) for questions used from the question bank separated by a comma.
(e.g., 1a, 3c, 130d)

*** Items below to be completed by Office of Associate Director for Communication (OADC)***
1. Number of burden hours remaining in current year's allocation:
2. OADC confirmation of time-sensitivity:
Yes:
No:

Project Officer
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