2 survey

Appendix 4: Screener

Form Approval

OMB No. 0925-0585-02 Expires 02/28/2011

Focus Group Screener

Public reporting burden for this collection of information is estimated to average 120 minutes per response. This time includes the length of time allotted for a focus group. 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN; PRA (0925-0585). Do not return the completed form to this address.

Groups and Locations

	Hispanic Men	Hispanic Women	African American Men	African American Women	MSM	Trans-gender (18+ yrs, any race/ethnicity)	TOTAL
NYC	1 (26-45 yrs, English speaking)	1 (26-45 yrs, Bilingual- Engl/Spanish speaking)	1 (26-45 yrs)	1 (26-45 yrs)	1 any race/ethnicity (26-45 yrs)	1	6
Miami	1 (45+ yrs, Bilingual- Engl/Spanish speaking)	1 (45+ yrs, English speaking)	1 (18-25 yrs)	1 (18-25 yrs)	1 Hispanic (18-25 yrs) 1 Hispanic (26-45 yrs)	-	6
Atlanta	1 (18-25 yrs, Spanish speaking)	1 (18-25 yrs, English speaking)	1 (45+ yrs)	1 (45+ yrs)	1 African American (18-25 yrs) 1 African American (26-45yrs)	-	6
Oakland	1 (18-25 yrs, English speaking)	1 (18-25 yrs, Spanish speaking)	1 (18-25 yrs)	1 (18-25 yrs)	1 any race/ethnicity (18-25 yrs)	1	6
TOTAL	4	4	4	4	6	2	24

Recruit 12 to seat 9 respondents in each focus group

Participant screening will be conducted over the phone. A professional recruitment vendor will contact individuals from their proprietary recruitment database. Please note that the vendor will have access to African American, Hispanic, MSM, and transgender populations.

Hello, I’m _______________ with _____________________, an independent consumer research firm. We are not selling or promoting any product or service. We are conducting a research study with adults to talk about health research issues. Everyone who participates in these discussions will receive $75. I would like to ask you some questions to see if you qualify for one of the discussion groups. These questions will only take a few moments to answer. The groups will be held at [Time] on [Date] in [City] and will last two hours or less. You will receive $75 when the discussion group ends. Do you have time now to answer a few questions?

Are you aged 18 or older? If no, is there anyone in the house aged 18 or older?

[If no one qualifies in the household, thank and terminate]

1. In the past 6 months have you participated in a market research study or interview where you were paid for your time and/or for providing your opinions?

( ) Yes Terminate

( ) No Continue

2. Have you or anyone in your home worked in or retired from any of the following industries?

(Read and record response)

( ) Marketing or public relations Terminate

( ) Advertising Terminate

( ) Market research Terminate

( ) Medical field (e.g., doctor, nurse, or lab or x-ray technician) Terminate

( ) Medical clinic, hospital or doctor’s office Terminate

For this project, it is important that we talk to groups of people from a variety of races, ethnicities, genders and sexual orientations. The next few questions will determine if you are part of one of the groups we are still recruiting for.

3. First, which of the following best describes your gender? [Read the first three responses before allowing participant to respond]

( ) Transgender (Recruit for Transgender Groups Only) Continue to Question 4

( ) Female (Recruit for Female Groups Only) Skip to Question 6

( ) Male (Recruit for Heterosexual Male or MSM Groups) Skip to Question 8

( ) Other, or refuses to answer Terminate

TRANSGENDER ONLY

4. Are you M2F/MTF or F2M/FTM?

( ) M2F/MTF Continue

( ) F2M/FTM Terminate

( ) Refuses to Answer Terminate

5. Which of the following racial/ethnic categories best describes you?

( ) African American/Black (Non-Hispanic) Skip to 11

( ) Hispanic Skip to 11

( ) Asian Skip to 11

( ) Caucasian/White (Non-Hispanic) Skip to 11

( ) Native American Skip to 11

( ) Other Skip to 11

Recruit as it falls.

FEMALE GENDER ONLY

6. Now I am going to ask about how you would describe your sexual orientation. Would you describe yourself as:

( ) Heterosexual Continue

( ) Bi-sexual Continue

( ) Homosexual or Lesbian Terminate

( ) Other Terminate

7. Which of the following racial/ethnic categories best describes you?

( ) African American/Black (Non-Hispanic) Skip to 11

( ) Hispanic Continue to 7a

( ) Asian Terminate

( ) Caucasian/White (Non-Hispanic) Terminate

( ) Native American Terminate

( ) Other Terminate

7a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?

( ) English Skip to 11

( ) Spanish Skip to 11

( ) Both English and Spanish Skip to 11

( ) Other Terminate

Recruit the following female groups:

Oakland- one Spanish

Atlanta- one English

New York- one Bilingual

Miami- one English

Conduct remainder of interview in Spanish for those who say Spanish

MALE GENDER ONLY

8. Now I am going to ask about how you would describe your sexual orientation. Would you describe yourself as:

( ) Heterosexual Continue

( ) Bi-sexual Skip to 9

( ) Gay or Homosexual Skip to 9

( ) Other Terminate

8a. Have you ever had sexual relations with another man?

( ) Yes (Recruit for MSM Groups Only) Continue to Question 9

( ) No (Recruit for Heterosexual Male Groups Only) Continue to Question 10

( ) Refuses to answer Terminate

MSM ONLY

9. Which of the following racial/ethnic categories best describes you?

( ) African American/Black (Non-Hispanic) Skip to 11

( ) Hispanic Skip to 11

( ) Asian Skip to 11

( ) Caucasian/White (Non-Hispanic) Skip to 11

( ) Native American Skip to 11

( ) Other Skip to 11

Recruit the following MSM groups:

Mixed MSM Groups: 30% African American, 30% Hispanic, and 40% of all remaining races

African American MSM Groups: 100% African American

Hispanic MSM Groups: 100% Hispanic

HETEROSEXUAL MALE ONLY

10. Which of the following racial/ethnic categories best describes you?

( ) African American/Black (Non-Hispanic) Skip to 11

( ) Hispanic Continue to 10a

( ) Asian Terminate

( ) Caucasian/White (Non-Hispanic) Terminate

( ) Native American Terminate

( ) Other Terminate

10a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?

( ) English Skip to 11

( ) Spanish Skip to 11

( ) Both English and Spanish Skip to 11

( ) Other Terminate

Recruit the following heterosexual male groups:

Oakland- one English

Atlanta- one Spanish

New York- one English

Miami- one Bilingual

Conduct remainder of interview in Spanish for those who say Spanish

FOR ALL GROUPS

OK, just a few more questions for our records.

11. Please tell me your age.

(Record actual age) ___________________

( ) Age 18 to 25 Continue

( ) Age 26 to 45 Continue

( ) Age 45+ (older than 45 years) Continue

Recruit as indicated in the table on page 1.

12. Which of the following categories best describes your total annual household income?

( ) Less than $15,000 Continue

( ) $15,001 to $30,000 Continue

( ) $30,001 to $40,000 Continue

( ) $40,001 to $60,000 Continue

( ) $60,001 to $75,000 Continue

( ) More than $75,000 Continue

Recruit half above median income and half below median income for each audience in each location.

(Median incomes to be determined once locations are finalized)

13. Which of the following categories best describes your level of education?

( ) Did not graduate high school Continue

( ) Completed high school Continue

( ) Some college/technical training/associate’s degree Continue

( ) Completed college Continue

( ) Graduate degree (master’s or higher) Continue

Recruit a mix.

14. Finally, can you think of a television show or movie that you watched lately? Can you tell me something about what happened in the film/program and why you enjoyed it?

This question is intended to establish whether the respondent is reasonably articulate, fluent in English or Spanish, and willing to converse. If respondent is difficult to understand or has trouble communicating (e.g., “shuts down”), thank and terminate.

Invitation

Thank you for answering my questions. I would like to tell you a little more about the discussion group. The group will meet on [Date] at [Time] at our focus group facility in [CITY, GIVE ADDRESS]. The group will consist of 8 other people, such as yourself, and a moderator. It will meet for 2 hours. You will receive $75 for participating. Several individuals working on this research study may observe the groups from behind a one-way mirror.

So that we can start and end on time, please plan to arrive about 15 minutes early to pick up your nametag. We are counting on your participation, so please be sure to contact us as soon as possible if something comes up and you can't attend. (GIVE PHONE NUMBER).

Also, do you wear glasses or use a hearing aid? If so, please remember to bring them. Some activities will involve reading and listening.

Has hearing aid  (check here)

Has glasses  (check here)

[ONLY if respondent asks for the topic of the focus group, please tell them “HIV vaccine research.” Please record if the participant asks about this and ask if they are still interested in participating. If the answer is “no” please ask why and record the answer.]

Before we hang up, let me get the correct spelling of your name, and your address and phone numbers so we can send you a confirmation letter with directions to our facility and give you a reminder call the day of the group.

NAME______________________________

HOME PHONE______________________

ADDRESS ____________________________________________

____________________________________________

WORK PHONE____________CELL PHONE _________E-MAIL_________

Thanks, again, for your time and we'll see you at the group!

Appendix 4: Focus Group Screener 7