Form SAMHSA PSA Recover SAMHSA PSA Recover SAMHSA PSA Recovery Focus Group Screener

Fast Track Generic Clearance for the Collection of Routine Customer Feedback - HHS Communication

SAMHSA PSA Recovery Attachment B - Focus Group Screening Questionnaire _ Clean

Recovery Campaign PSA Pretesting Focus Group Protocols

OMB: 0990-0459

Document [docx]
Download: docx | pdf

Attachment B

Focus Group Recruitment and Screening

OMB No. 0990-0459

Expiration Date: 8/31/2023


Public Burden Statement: 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. The OMB control number for this project is 0990-0459. The public reporting burden for this collection of information is estimated to average 4 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-A, Rockville, MD 20857.




Screener for Testing

In Support of Recovery from Substance Abuse Campaign aimed at Young Adults Ages 18-29



For these focus groups, recruitment will focus on securing 6–8 participants per group.


PARTICIPANTS SELECTION CRITERIA

  • Participants must be at least 18 years old, and no older than 29 years old

  • Participants who are currently in active recovery or living a sober lifestyle.



Additionally, each focus group will look to feature a balanced mix of (see recommended quotas listed below, table 1):

  • Males, females, non-binary/other;

  • Racial/ethnic groups;

  • Geographic distribution (i.e., urban, suburban, rural, etc.); and


Education level (i.e., high school graduate, GED, college experience)

EXCLUSION CRITERIA

  • Individuals who are under 21, or over 29 years old

  • Individuals who do not speak English

  • Individuals who are not in active recovery


Recruitment Objectives

Recruitment will focus on securing 6–8 young adults aged 18-29 who are willing and available to participate in a FGD session of 90 minutes (about 1 hour and 30 minutes), preferably during evening hours. The overall recruitment strategy will also follow the recommended participant quota distribution approach outlined below to ensure greater diversity.




RECOMMENDED PARTICIPANT QUOTA DISTRIBUTION


FGD #1

FGD #2

FGD #3

FGD #4

TOTAL

Gender

 

 




Female

3

3

3

3

12

Male

3

3

3

3

12

Non-binary or other

3

3

3

3

12

Participant’s Age






18-21

2

2

2

2

8

22-25

2

2

2

2

8

26-29

2

2

2

2

8

Racial/Ethnic Group






American Indian, Alaska Native;

Native Hawaiian other Pacific Islander

1

1

1

1

4

Asian

1

1

2

2

6

Black/African American

2

1

1

2

6

White

3

3

3

2

11

Hispanic/Latino

1

2

1

2

6

Are you in active recovery? (I.e., seeking out resources on recovery, in a 12-step group etc.)?






Yes

5

5

5

5

20

No

3

3

3

3

12




SCREENING QUESTIONNAIRE


Hello. My name is ___________________. I work at _____ (organization’s name

We are interested in talking with young adults ages 18-29. The purpose of these is to get ideas for public health campaigns about being in recovery from or seeking treatment for substance use. As we are beginning the development of this product, we want your participation in reviewing three concepts that have been created. We would like to hear from young adults about their opinions, suggestions, and concerns about the proposed concept, to make it more relevant and appealing for this target population.


      1. Are you interested in participating in this focus group session?

Yes ⃝ No [if no, terminate: “Thank you very much for your time. Have a good day/evening, goodbye.”]


      1. Are you available to participate in a 90-minute focus group session during the week of:

[April/May 2022 TBA - includes dates and time for each session.]

Yes ⃝ No [if no, thank and terminate “Based on your availability, we cannot include you this time. Thank you for your consideration and interest.”]


Recruiter: “I am going to ask you some questions that will indicate whether you qualify to participate in this focus group.”

      1. Age [recruit a mix – wait for response]

18–29 years old

30–39 years old [if 30-39, thank and terminate “Based on your availability, we cannot include you this time. Thank you for your consideration and interest.”]

40–50 years old [if 40-50, thank and terminate “Based on your availability, we cannot include you this time. Thank you for your consideration and interest.”]

51–60 years old [if 51-60, thank and terminate “Based on your availability, we cannot include you this time. Thank you for your consideration and interest.”]

61+ years old [if over 61, thank and terminate “Based on your availability, we cannot include you this time. Thank you for your consideration and interest.”]

[Record actual age ________]




      1. Are you of Hispanic, Latino, or Spanish origin?

Yes – [CONTINUE]

No – [CONTINUE]


      1. What is your race? Select all that apply. [Do not read, wait for the response.]

American Indian/Alaska Native

Asian

Black/African American

Native Hawaiian/Other Pacific Islander

White


      1. Please select which option describes you best.

I only speak English. [CONTINUE]

I am an English-dominant speaker. [CONTINUE]

I am a Spanish-dominant speaker. [if no, thank and terminate “Based on your response, we cannot include you this time. Thank you for your consideration and interest.”]

I am bilingual in English and Spanish. [CONTINUE but check recommended quota for each focus group.]


      1. Gender: ⃝ Female ⃝ Male ⃝ Non-binary/Other

8. Have you ever participated in a substance abuse treatment program and/or consider yourself in active recovery/sober?"

Yes

No [ If no, thank and terminate “Based on your response, we cannot include you this time. Thank you for your consideration and interest.”]


Recruiter: “Thank you for answering these questions. If you are selected as a focus group discussion participant, you will receive a call from me, and/or an e-mail to confirm your participation, and to be informed of the venue/platform, date, and time of the session. Could you please provide us with information about the best way to contact you?”


Name: _____________________________________________________________________


E-mail: _________________________________Phone/Mobile: _______________________



9


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleScreener for Focus Groups for Gatlinburg Department of Tourism
AuthorLuz Amparo Pinzon
File Modified0000-00-00
File Created2023-07-29

© 2025 OMB.report | Privacy Policy