FNS Core Nutrition Messages Concept Testing

Attachment A: Focus Group Screening Questionnaire for Low-Income Mothers

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time to complete this information collection is estimated to average 15 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.

USDA/FNS

Focus Group Screening Questionnaire – Low-Income Mothers

TBD 2007

Rochester, NY; Baltimore, MD; Dallas, TX

RESEARCH CONTACT: Taryn Antigone at 202-973-3623 or [email protected]

DATES: TBD

SPECS:

• Two, 90-minute focus groups with low-income mothers:

  • Mothers with at least one non-school aged child (i.e., 2-5 years of age and not yet in kindergarten)

  • Mothers with at least one child in elementary school, up to 10 years of age

• Recruit 12 for 8 to show at each group.

• Each woman must be in a low income household (see Q13 and Q14).

• All respondents must speak English.

• All respondents must be outgoing, responsive, articulate, willing and able to read and react to written materials, and must be willing to speak openly in a group.

PLEASE SCHEDULE/RECRUIT RESPONDENTS AS FOLLOWS:

	GROUP	DATE*	TIME	LOCATION
[ ]	Group 1: low-income mothers of non-school aged children			Rochester
[ ]	Group 2: low-income mothers with at least one child in elementary school			Rochester
[ ]	Group 3: low-income mothers with at least one child in elementary school			Baltimore
[ ]	Group 4: low-income mothers of non-school aged children			Baltimore
[ ]	Group 5: low-income mothers of non-school aged children			Dallas
[ ]	Group 6: low-income mothers with at least one child in elementary school			Dallas

Hello, my name is _____with______. We are conducting a study about nutrition on behalf of the federal government, and I would like to ask you a few questions. I’m not trying to sell you anything. We would like to invite a number of women in your area to participate in a focus group to help us understand more about what they think about nutrition and health. May I speak to the female head of household? This should only take a few minutes. ONCE HEAD OF HOUSEHOLD ON PHONE, REPEAT INTRODUCTION AND READ OMB STATEMENT (see top of screener).

1. Record Gender—DO NOT ASK UNLESS UNABLE TO TELL.

Female……	[ ]	Continue
Male ……..	[ ]	Terminate

2. Do you, or does anyone in your household, work for a radio station, television station, newspaper, market research company, advertising or public relations company?

Yes……	[ ]	Terminate
No……..	[ ]	Continue

3. Do you have any children under age 19 living at home?

Yes…………	[ ]	Continue
No …….…..	[ ]	Terminate

4. How old are your children? [check all that apply]

Under 2…………	[ ]
2-5 years old.…..	[ ]	If one of these is checked, continue. If not, terminate.
6-10 years old.….	[ ]
11 and up…...…..	[ ]

5. [If child is between the ages of 2-5, ASK] Is your child in Kindergarten?

Yes……………….	[ ]	Recruit for older group
No.………………	[ ]	Recruit for younger group

6. [If child is between the ages of 6-10, ASK] What grade is your child in?

____________ [Record answer] Recruit for older group

7. Do you or does anyone in your household work in any of the following industries? [Record each “yes” response.]

Healthcare……………………………	[ ]	Terminate if “YES” to any
Nutrition…………………..	[ ]
Fitness…………………………..	[ ]

8. Have you ever participated in a focus group or been paid to be part of a discussion group?

Yes……..………………	[ ]	Continue
No………………………	[ ]	Skip to Q10

9. How recently did you participate in a focus group?
   
   

Less than 6 months ago	[ ]	Terminate
6 months ago or longer	[ ]	Continue

10. Generally speaking, do you consider yourself to be an “expert” in nutrition?

No………………….	[ ]	Continue
Yes …….…….……	[ ]	Terminate
Don’t know/Refused...	[ ]	Terminate

11. Do you or your child(ren) have any health condition where you have to eat a special diet, or are you on a diet prescribed by your doctor?

No………………….	[ ]	Continue
Yes …….…….……	[ ]	Terminate

12. Are you a vegetarian or vegan?

No………………….	[ ]	Continue
Yes …….…….……	[ ]	Terminate

13. Who does most of the grocery shopping or makes the shopping lists in your household? [DO NOT READ RESPONSES]

You………………….	[ ]	Continue
Someone else…….…….……	[ ]	Terminate

14. Including yourself, how many people currently live in your household?

__________ [Record answer]

15. What is your total annual household income? [Do not read list]

Less than $19,000…………	1	Record number below
$19,000 - $25,000…………	2	Record number below
$25,001 - $32,000…………	3	Record number below
$32,001 - $38,000…………	4	Record number below
$38,001 - $45,000…………	5	Record number below
$45,001 - $51,000…………	6	Record number below
$51,001 - $58,000…………	7	Record number below
$58,001 - $64,000…………	8	Record number below
More than $64,000………..	[ ]	Terminate
Don’t know/Refused ……...	[ ]	Terminate

Answer to question 14: ____________ Answer to question 15: _______________

Accept respondent if he/she falls into one of the following categories:

___ Has 1 person in household (Q14), and answer to Q15 is 1.

___ Has 2 people in household (Q14), and answer to Q15 is 1 or 2.

___ Has 3 people in household (Q14), and answer to Q15 is 1, 2, or 3

___ Has 4 people in household (Q14), and answer to Q15 is 1, 2, 3, or 4

___ Has 5 people in household (Q14), and answer to Q15 is 1, 2, 3, 4, or 5.

___ Has 6 people in household (Q14), and answer to Q15 is 1, 2, 3, 4, 5, or 6.

___ Has 7 people in household (Q14), and answer to Q15 is 1, 2, 3, 4, 5, 6, or 7.

___ Has 8+ people in household (Q14), and answer to Q15 is 1, 2, 3, 4, 5, 6, 7, or 8.

[INTERVIEWER, RECORD WHICH CATEGORY RESPONDENT FALLS INTO]

16. What is your current age? [Do not read list]

Under 18…………	[ ]	Terminate
18-34 …….……...	[ ]	Record
35-50…….………	[ ]
50+ ……...	[ ]	Terminate

17. What is your race or ethnicity? (Read list. Record one answer)

Black or African American …….………	[ ]
Hispanic or Latino ……...	[ ]
White………………………………………	[ ]	Recruit no more than 5*
American Indian or Alaska Native………...	[ ]
Asian ….…….…………………………….	[ ]
Native Hawaiian or Other Pacific Islander..	[ ]
(Do not read) Other……………………….	[ ]	Terminate only if response is inarticulate

*Recruit no more than 5 White respondents for each group. The remaining 7 recruits can be any mix of other races, but should not all be of one racial or ethnic group. To the extent possible, these 7 should be split between Hispanics and African Americans.

18. What is the highest level of education you have completed? [Do not read list]

High school graduate or less.…….….	[ ]	Recruit a mix
Some college, vocational or technical school………………………………...	[ ]
College graduate……………	[ ]	Recruit no more than 3
Post graduate education (e.g., Master’s degree, MBA, law degree, PhD)	[ ]	Terminate

19. How comfortable would you be reading an information pamphlet that is written in English and telling

someone what you think about it?

Very comfortable.…….….	[ ]	Continue
Somewhat comfortable……………………...	[ ]	Continue
Somewhat uncomfortable……………	[ ]	Terminate
Very uncomfortable……………	[ ]	Terminate

20. Are you currently employed?

Yes, full-time……………...	[ ]	Recruit a mix of employed and not employed
Yes, part-time………………	[ ]
No…………………………	[ ]

21. Are you ……….

Married………………………...	[ ]	Recruit a mix
Single, never married …………	[ ]
Separated/divorced/widowed…	[ ]

22. Are you or your child participating in any one of the following nutrition programs? [select all that apply]

Food Stamp Program………..............................	[ ]	Record
Free- or Reduced-price School Lunch …………	[ ]
Women, Infants, and Children Program (WIC)…	[ ]

23. Take a moment and think about your health. What is the biggest concern you have about your health and why?

Recruiter: After recording respondent’s answer, determine whether or not you feel this respondent would be useful in the group. Did she:

Give full and complete answer?

Speak clearly, and without long pauses?

Answer enthusiastically?

Speaks understandable English/is comfortable with the English language

It is most important that respondent be articulate!! If not, terminate.

I would like to invite you to participate in a group discussion that will be held at our facility on (DATE) at (TIME). The group will last approximately 90 minutes. To help cover costs such as transportation to the focus group site and child care, you will receive $75.00 in cash at the end of the group session. Would you be willing to participate?

Yes……………( ) SCHEDULE No……………..( ) TERMINATE

I will call you to remind you of this appointment. However, if for some reason you are unable to attend, please call me at (TELEPHONE NUMBER) so that I can find a replacement for you. Thank You.

Respondent’s name: ___________________________________________

Address: ____________________________________________________

Telephone # (Home): __________________ (Work) _________________

Recruited by: _________________________________________________

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