Screening Process for Parents Recruited to Parent-only Groups in Phase 3

Appendix D3

Recruitment Screener for

Parent-Only Groups

Instructions:

This form will be used in Phase 3 to recruit parents of children between the ages of 2-4 to participate in focus groups.

This form serves the following purposes:

1. Assess interest and eligibility of parent to participate in the focus group.

Form Approved

OMB No. 0920-XXXX

Exp. Date: _______________

SCREENER D3 for Parent-Only Focus Groups

Project: “Formative Research of Adults’ and Childrens’ Views Related to Promotion of Health Food Choices”

PHASE 3: Focus groups with Parents of children aged 2-4.

Date: _______________

Letter sent: _______________

Reconfirmation Call: _______________

AED – Obesity Focus Groups – Pr # 666-65

CITIES/DATES/TIMES – TBD

SCREENER FOR PARENTS OF CHLDREN AGES 2-4

ASK TO SPEAK TO PARENT WHO HAS A CHILD BETWEEN THE AGES OF 2 AND 4. [CONFIRM THAT YOU ARE SPEAKING TO A PARENT IN THE HOUSEHOLD. EXPLAIN THAT WE ARE RESEARCHERS LOOKING FOR PARENTS OF PRESCHOOL OR SCHOOL AGED CHILDREN WHO WOULD BE INTERESTED IN PARTICIPATING IN A FUTURE RESEARCH PROJECT.

EXPLAIN THAT THE PROJECT INVOLVES FOCUS GROUPS. THE DISCUSSION TOPIC WILL BE ABOUT FOOD.

EXPLAIN THAT WE WOULD LIKE TO ASK THE PARENT A FEW QUESTIONS TO DETERMINE THEIR LEVEL OF INTEREST AND WHETHER THE PARENT IS ELIGIBLE AND INTERESTED. EXPLAIN THAT YOUR QUESTIONS WILL TAKE APPROXIMATELY 7 MINUTES.

Public reporting burden of this collection of information is estimated to average 7 minutes per respondent, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, ad completing and reviewing the collection of information. As 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX)

RECRUIT 8 PER GROUP (FOR 6 TO 8 TO SHOW)

NOTE: WE WILL BE CONDUCTING FOCUS GROUPS WITH PARENTS OF CHILDREN AGES 2-4. THE PARENT MUST BE THE PRIMARY MEAL PLANNER AND GROCERY SHOPPER.

Hello, I’m __________ with Alan Newman Research, an independent consumer research firm. We are not selling or promoting any product or service. We are conducting a research study on food choices among parents of children ages 2-4 on behalf of the Centers for Disease Control and Prevention. We would like to ask you a few brief questions now over the phone. We’d like to determine if you are interested in and available to participate in a focus group study in a few weeks. There are a few qualifiers for our particular study we’d like to ask you about to determine your eligibility. Our questions will only take approximately7 minutes. May I start with the first question?

1. First, do you, or any member of your household, work:

For a market research company _____

For an advertising agency or public relations firm _____

In the media (TV/radio/newspapers/magazines) ____

As a healthcare professional (a doctor, nurse, nutritionist, pharmacist, etc.) _____

[IF YES TO ANY >> TERMINATE]

NOTE: Use the following language to “terminate” throughout the screening process:

“We want to thank you for taking the time to answer our questions.” Unfortunately, the category that you (and your child) fall into is currently full. If it should open back up, may we call you back?”

2. Do you have any children in your household who are between the ages of 2 and 4?

[IF NO, TERMINATE.

IF YES, GO TO 3.

3. When it comes to food, which best describes you:

I am the primary decision-maker _____

We share the decisions equally (made with spouse/partner) _____

Those decisions are most often made by your spouse or someone else _____

T

If not qualified, read …. “Thank you so much for answering our questions. Unfortunately, the category you fall into is currently full. May I speak with your (spouse or another adult decision-maker) to see if he/she is interested in taking part in our study?”

[If “Yes”, speak with decision-maker & begin again].

[If “No”, read…]

“Thank you again for taking the time to speak with us today. If the category you fall into should open up, would you like us to call you back?” (Yes) (No) circle one

ERMINATE or GET REFERRAL > see box below >if reply is: Those decisions are most often made by your spouse of someone else.

4. Which of the following categories best describes your total, annual, household income before taxes? [NEED GOOD MIX OF LOWER TO MIDDLE CLASS INCOMES]

[ACTUAL INCOME AMOUNTS WILL VARY BY CITY]

Under $25,000 _____

$25,000 - $34,999 _____

$35,000 - $39,999 _____

$40,000 - $49,999 _____

$50,000 - $74,999 _____

$75,000 - $99,999 _____

$100,000 or greater _____

5. So that we can be sure that all backgrounds are represented in our study, please tell me your ethnic origin and race. Would you say that you are… ?

[GROUPS ARE RACE SPECIFIC. CHECK QUOTAS]

Hispanic or Latino _____

Not Hispanic or Latino _____

Prefer not to answer _____

AND

Do you consider yourself to be (select one or more):

American Indian or Alaska Native _____

Asian _____

Native Hawaiian or Other Pacific Islander _____

Black or African American _____

White _____

Prefer not to answer _____

Note: If parent does not identify any of the 3 ethnicities needed in the study, or if the parent does not identify an ethnicity, thank them for their time and terminate.

6. What is the highest level of education you personally have completed? [NEED GOOD MIX]

TERMINATE >> Less than high school graduate/some high school _____

High school graduate _____

Some college _____

College graduate _____

MAX. 1-2 PER GROUP >> Post graduate studies or degree _____

7. Have you ever attended a focus group discussion? By that we mean an informal, round-table discussion, conducted by a professional moderator, in which you were asked your opinions regarding a product, a service, or advertising?

ATTEMPT MAX. ½ GROUP >> ASK A-C >> Yes _____

INVITE TO GROUP >> No _____

1. How many of these groups have you attended?

______________________________ [MAX. 2 EVER]

2. What was/were the topics discussed?

______________________________

[IF NUTRITION-RELATED, GET SPECIFICS & HOLD FOR APPROVAL]

3. How long ago was the last one of these groups you attended?

______________________________ [MUST BE AT LEAST 6 MONTHS AGO]

As I mentioned earlier, we are conducting a study with parents of preschool and school-age children regarding topics related to food and nutrition. We would like to invite you to participate In this focus group discussion on [date] at [time]. You will participate in a discussion with other adults with children ages 2-4. The discussions will last about 2 hours. Just to remind you, you will receive $50 for participating. No one will call you as a result of your participation. We are not selling or promoting anything and your responses will remain anonymous and be treated in a confidential manner. Can we schedule your participation? If yes,

If parent accepts invitation, read ….

“When you arrive, you will receive an adult consent form to complete and sign.”

Please be sure that you have signed the appropriate form and remember to bring the completed form with you to the session when it convenes.

[Record Group] Parent: Group X _____

----------END of Parent only screener--------------