0920-1154 Focus Group Recruitment Screen

Att G

RECRUITMENT SCREENER

Project: ACOG – Provider Attitudes & Behaviors Regarding Zika

Audience: Ob-gyns, Pediatricians, Nurse Practitioners, and Certified Nurse-Midwives

Method: Online focus groups

RECRUITMENT OBJECTIVE: The target audience is ob-gyns, pediatricians, nurse practitioners, and certified nurse-midwives. For each group, we will recruit up to 20 participants, with the expectation that we will likely lose a few participants on the day of the group, but the group will not proceed without a minimum of 8 participants.

Group 1 will consist solely of pediatricians.

Group 2 will consist solely of ob-gyns.

Group 3 will be a mix of ob-gyns and pediatricians from geographic areas where Zika is an emerging health threat (with equal representation from Florida, Texas, New York, and California).

Group 4 will be a mix of general, women’s health, and pediatric nurse practitioners and certified nurse-midwives.

Welcome screen

Thank you for your participation in this survey. The purpose of this research study is to understand your perceptions of important issues facing the United States.

Your participation is very important. Every opinion is important!

All responses are confidential. No individual comments recorded in the survey will be released; all information will only be reported in the aggregate.

Termination screen

Thank you for your interest in this survey. We ask a variety of questions to make certain we have a representative sample. Your responses indicate that you fall into a group that is full. Again, thank you for your interest in the survey.

End Screen

You have successfully completed the survey. Thank you for your participation!

If you are satisfied with all of your responses please click on the submit button below to confirm that your survey has been submitted.

Q1. Which of the following best describes your profession: [SELECT ONE]
Doctor	CONTINUE
Nurse or Nurse Practitioner	CONTINUE
Midwife	CONTINUE
Pharmacist	TERMINATE
None of the above	TERMINATE
Other	TERMINATE

Q2. [ASK DOCTORS ONLY] Please tell me what your primary medical specialty is: [RANDOMIZE] [SELECT ONE]
Pediatrics	Group 1 QUOTA: 20 Group 2 QUOTA: 0 Group 3 QUOTA: 10
Obstetrics/gynecology	Group 1 QUOTA: 0 Group 2 QUOTA: 20 Group 3 QUOTA: 10
Cardiology	TERMINATE
Infectious Diseases	TERMINATE
Oncology	TERMINATE
Other	TERMINATE

Q3. [ASK OBGYNs ONLY] Which of the following best describes the scope of your practice: [SELECT ONE]
I treat only pregnant women (obstetrics only)	CONTINUE
I treat both pregnant women and those who may consider or are planning pregnancy (obstetrics and gynecology)	CONTINUE
I treat only women not currently pregnant but who may consider pregnancy in the future (gynecology only)	CONTINUE
I treat only women not currently pregnant and who are NOT planning for future pregnancy	TERMINATE
Other (such as gynecological oncology, urogynecology, etc.)	TERMINATE

Q4. [ASK PEDIATRICIANS ONLY] Which of the following best describes your area of practice within the field of Pediatrics: [RANDOMIZE] [SELECT ONE]
Generalist	CONTINUE
Pediatric Infectious Disease	CONTINUE
Pediatric Endocrinologist	TERMINATE
Pediatric Gastroenterologist	TERMINATE
Pediatric Oncologist	TERMINATE
Pediatric Cardiologist	TERMINATE
Other	TERMINATE

Q5. [ASK OBGYNS AND PEDIATRICIANS ONLY] Are you currently a member of any of the following groups: [RANDOMIZE]
	Yes	No
The American Congress of Obstetricians and Gynecologists (ACOG)	1	IF OBGYN: TERMINATE ELSE: CONTINUE
The American Medical Association (AMA)	1	2
American Academy of Pediatrics	1	IF PED: TERMINATE ELSE: CONTINUE
American Association of Nurse Practitioners (AANP)	1	2

Q6. [MIDWIVES ONLY] Which of the following best describes your highest level of certification: [RANDOMIZE] [SELECT ONE]
Certified Nurse Midwife (CNM)	CONTINUE
Certified Midwife (CM)	TERMINATE
Certified Professional Midwife (CPM)	TERMINATE
Direct-Entry Midwife (DEM)	TERMINATE
Lay Midwife	TERMINATE
None of the above	TERMINATE
Other	TERMINATE

Q7. [NURSES ONLY] Which of the following best describes your highest level of certification: [RANDOMIZE] [SELECT ONE]
Certified Nursing Assistant (CNA)	TERMINATE
Licensed Practical Nurse (LPN)	TERMINATE
Registered Nurse (RN)	TERMINATE
Nurse Practitioner (NP)	CONTINUE
None of the above	TERMINATE
Other	TERMINATE

Q8. [NURSES ONLY] Which of the following best describes the scope of your practice: [RANDOMIZE] [SELECT ALL THAT APPLY]
Emergency	TERMINATE
Family	CONTINUE
Neonatal intensive care	CONTINUE
Pediatrics	CONTINUE
Women’s health	CONTINUE
Perinatal	CONTINUE
Midwifery	CONTINUE
None of the above	TERMINATE
Other	TERMINATE

Q9. How many years have you been practicing medicine?
3 years or less	RECRUIT A MIX
4-10 years
11-15 years
16-20 years
21-25 years
25 or more years

Q10. What percent of your professional time is spent treating patients, as opposed to non-clinical activities, such as research or technology?
___________ % of time spent in patient care	IF < 75% TERMINATE; ELSE=CONTINUE

Q11. Where do you spend the most time practicing medicine? [RANDOMIZE] [SELECT ONE]
Hospital – academic or university affiliation	CONTINUE
Hospital – community hospital
Office or clinic affiliated with or owned by a hospital or health system
Private office or clinic not affiliated with or owned by a hospital or health system
Other (please specify ______)

Q12. How frequently do you have discussions with your patients about the following medical conditions: [RANDOMIZE]
	Frequently	Sometimes	Rarely	Never
Zika virus	1	2	3	GROUPS 1,2,4: MAX 4 GROUP 3: TERMINATE
HPV	1	2	3	4
MRSA	1	2	3	4

Q13. [FOR GROUP 3 RECRUITMENT ONLY] Is your practice located in any of the following states?
California	RECRUIT A MIX
Florida
Texas
New York
Not located in one of these states	TERMINATE

Q14. Which of the following categories includes your age:
Less than 25 years of age	TERMINATE
25 to 34	CONTINUE
35 to 44
45 to 54
55 to 60
Over 60	TERMINATE

Q15. Which of the following best describes your ethnic background?
Caucasian or White	MAX 13
African American	CONTINUE
Hispanic or Latino
Asian American
Indian American
Native American
Other/Several backgrounds
Prefer not to answer

Q16. What is your gender?	Male	Female
	RECRUIT A MIX

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