KAB for Antibiotic Use - screener

Form Approved

OMB No. 0920-0798

Exp: 01/31/2011

Attachment 2 – Screening Instruments

Summary Specifications: 2-1: Screening instrument for mothers focus groups: health issues surrounding antibiotics

• Three (3) computer-assisted telephone (CAT) focus groups will be conducted

• For each group recruit 8 for 6 to show.

• All participants will:

1. Have at least one child between age 2 and 12 years old covered by medical insurance, including prescription drug coverage; lack of coverage is not susceptible to change with an education or communication intervention

2. Have no child with a weakened immune system or disease, such as severe asthma, that tends to lead from URI symptoms into a bacterial infection

3. Have not participated in a health-related market research study within the past six (6) months; this avoids participants who may confuse recent focus group content and purpose with the current one.

4. Be 21- 45 years old, a large age span for mothers of children this age. No women who are currently pregnant.

5. Speak English fluently and comprehensibly; each group must speak the same language.

6. Have earned at least a high school diploma and at least half must have at least some college but not hold a doctoral degree.

Each of the three groups will be relatively homogeneous on age, to encourage mutual communication from similar life stages. Specifically, a separate group each will contain only mothers who are ages:

• 21-29;

• 30-39; and

• 40-45.

Public reporting burden of this collection of information is estimated to average 10 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. 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0798).

Collectively, the geographic and racial/ethnic mix of the 24 participants will be diverse. Within each group (to the extent feasible) participants will come from:

• All regions of the U.S. (West, Midwest, East, North, and South)

• Urban (3), suburban (3), and rural (2) settings

• Hispanic American (2), African American (2), and Caucasian/ other (4) racial/ethnic groups. These are the three largest categories of the U.S. population; each focus group is too small to include less populated categories.

Form Approved

OMB No. 0920-0798

Exp: 01/31/2011

2-2: Screening Instrument: Mothers focus groups

Hello. My name is __________________ and I am calling from _______________, a market research firm. We are talking today with people across the country on behalf of the Centers for Disease Control and Prevention (CDC) about a common public health issue. [IF NECESSARY: We are not selling anything; it will only take about 5 minutes, depending on your answers.]

ASK TO SPEAK TO AN ADULT WOMAN IN THE HOUSEHOLD. WHEN SHE IS ON THE PHONE, REPEAT ABOVE INTRODUCTION IF NECESSARY. IF NO ADULT WOMAN LIVES IN THE HOUSEHOLD, THANK AND TERMINATE.

1. Are you, or is anyone in your household, a doctor, nurse, or other healthcare professional?

01 Yes (THANK AND TERMINATE)

02 No (CONTINUE)

2. Are you, or is anyone in your household, trained as a biological or medical researcher?

01 Yes (THANK AND TERMINATE)

02 No (CONTINUE)

3. Have you or anyone in your household ever worked for any of the following?

01 Advertising, public relations and/or market research

02 Any form of news media – TV, radio, newspaper, magazine, or Internet

03 A health clinic, doctor or dentist’s office, hospital, medical laboratory or

research institution, health insurance company or agency, pharmacy,

pharmaceutical company, or public health organization

04 Other health related field

(THANK AND TERMINATE IF YES TO ANY)

Public reporting burden of this collection of information is estimated to average 10 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. 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0798).

4. Have you ever participated in a focus group, or been paid to participate in a discussion group or interview?

____ Yes (CONTINUE)

____ No (SKIP TO Q.7)

5. What was that focus group, discussion, or interview about?

____________________________________

IF TOPIC WAS NOT HEALTH OR MEDICAL: GO TO Q.7

IF TOPIC WAS HEALTH OR MEDICAL: GO TO Q. 6

5. About how long ago was that?

_____________________________________

IF LESS THAN 1 YEAR THANK AND TERMINATE

5. Document Gender

01 Male (SWITCH TO HEALTHY ADULTS SCREENER)

02 Female (CONTINUE)

5. How old are you? ______________ (DOCUMENT ON GRID)

01 Under 21 (THANK AND TERMINATE)

02 21 – 29 (CONTINUE FOR GROUP 1)

03 30 – 39 (CONTINUE FOR GROUP 2)

04 40 – 45 (CONTINUE FOR GROUP 3)

05 46 or older (SWITCH TO HEALTHY ADULTS SCREENER)

06 Refused (THANK AND TERMINATE)

8b. Which of the following statements best describes the highest level of education you have completed?

(READ LIST; AT LEAST HALF MUST HAVE SOME COLLEGE OR MORE)

I did not graduate from high school 1 (THANK & TERMINATE)

I am a high school graduate 2 (RECORD & CONTINUE)

I took some trade school, junior college, community college or college classes but did not graduate 3 (RECORD & CONTINUE)

I am a trade school graduate 4 (RECORD & CONTINUE)

I graduated from a junior college or a community college 5 (RECORD & CONTINUE)

I graduated from a 4-year college 6 (RECORD & CONTINUE)

I have taken post-graduate courses, but do not have a post-graduate degree …..……… 7 (RECORD & CONTINUE)

I have a master’s degree .………..8 (LIMIT 2 PER GROUP; NO JDs)

I have a doctoral degree 9 (THANK & TERMINATE)

9. Are you currently pregnant? (if yes TERMINATE)

10. Are you the birth mother, adoptive mother, or step-mother of any children?

01 Yes (CONTINUE)

02 No (SWITCH TO HEALTHY ADULTS SCREENER)

11. How old is your youngest child? __________ (RECORD)

01 Less than 2 years old (THANK AND TERMINATE)

02 Between 2 and 12 years old (CONTINUE)

03 12 or older (SWITCH TO HEALTHY ADULTS SCREENER)

12. How many children under the age of 12 do you have and what are their ages?

RECORD AGES

01 No other children

02 Ages: ___________________________________________________

13. Who usually makes healthcare decisions for [THESE CHILDREN UNDER 12]?

01 Self (or self and partner together) (CONTINUE)

02 Someone else (THANK AND TERMINATE)

14. Do any of your children have a weakened immune system or disease, such as severe asthma, that tends to lead from sniffles, coughing, or wheezing into a bacterial infection, such as pneumonia?

1. No (CONTINUE)

2. Yes (THANK AND TERMINATE)

15. About how many hours per week do you work outside the home?

01 0-19 (RECRUIT 3-4 PER GROUP)

02 20 or more (RECRUIT 3-4 PER GROUP)

16. When you have a new prescription filled for your child/ren 12 years old or younger, which of the following statements best describes how much you pay? (READ RESPONSES)

Nothing – a health plan pays all of it	1	CONTINUE
You (or another family member or partner) pay part of it and a health plan pays the rest	2	CONTINUE
You (or another family member or partner) pay the entire cost of the medication	3	THANK & TERMINATE

[THE CRITICAL FACTOR HERE IS THAT THEY HAVE PRESCRIPTION DRUG COVERAGE; IF THE CAREGIVER OR ANOTHER PERSON IS PAYING THE OUT-OF-POCKETS FOR THE PATIENT, THEY STILL QUALIFY.]

17. How would you describe the geographic area where you live? Is it a...

(RECRUIT A MIX)

1. Rural area (Recruit 1-2)

2. Small city or town (Recruit 1-2)

3. Suburb (Recruit 2-3)

4. Large city (Recruit 2-3)

18. Which of the following best describes your race or ethnicity?

01 American Indian or Alaska Native

02 Asian

03 Black or African American

04 Hispanic or Latina

05 Native Hawaiian or Other Pacific Islander

06 White

19. In your opinion, what is the biggest problem in American healthcare today?

[RECORD EXACT RESPONSE. Participants must be articulate, fluent in English, and willing to converse. If respondent has a strong accent, difficulty speaking English, serious speech impediment or has trouble communicating (e.g., “shuts down,” thank and terminate.]

20. We would like you to participate in a confidential telephone discussion group with other moms like you all over the country to talk about some health issues. It will take no more than 90 minutes and we’ll pay you or your favorite charity $50. All you’ll need is a land line phone to take this call. The session will include reading some short materials and then discussing them. Are you comfortable reading written materials?

01 Yes [CONTINUE]

02 No [THANK AND TERMINATE]

21. Since these discussions take place over the phone, you can participate from your home, your office, or anywhere else you need to be. All that we ask is that you participate from a regular telephone, not a cell phone. A conference operator will call you at the number of your choice. When everyone is on the line, a discussion leader will introduce everyone by first name only, and will then lead the group through several topics.

[ENTHUSIASTICALLY] Will you be able to join us on [DAY, DATE] at [CONVERT TIME INTO PARTICIPANT’S LOCAL TIME]?

01 Yes [CONTINUE]

02 No [THANK AND TERMINATE]

IF NECESSARY, EXPLAIN THAT THE DISCUSSION IS NOT A SALES PITCH.

(SCHEDULE DATE/TIME WHEN INTERVIEWEE AND INTERVIEWER ARE AVAILABLE)

Group 1 (Age 21-29) – Day, Date, Time

Group 2 (Age 30-39)– Day, Date, Time

Group 3 (Age 40-45) – Day, Date, Time

22. At what phone number shall we call you then? _________________________

23. We will send you a confirmation e-mail in a few days and a reminder of your interview time a few days before the interview. May we please have the following contact information:

INTERVIEWEE’S NAME: _______________________________________________________

E-MAIL ADDRESS: ___________________________________________________________

STREET ADDRESS: ___________________________________________________________

CITY: __________________________, STATE: __________ ZIP: ________________

HOME PHONE: ________________________________

WORK PHONE: ________________________________

Thank you very much—you should receive our materials shortly

Form Approved

OMB No. 0920-0798

Exp: 01/31/2011

2-3: summary specifications:

screening instrument for healthy adults focus groups: health issues surrounding antibiotics

The second target audience to be recruited for this research is healthy adults. Three (3) computer-assisted telephone (CAT) focus groups will be conducted with them. Eight participants will be recruited for each focus group. All participants will:

1. Be 25-55 years old, a core range of independent and healthy adult life. No pregnant women allowed in the group.

2. Will not have a weakened immune system or disease, such as severe asthma, that tends to lead from URI symptoms into a bacterial infection

3. Be covered by medical insurance, including prescription drug coverage; lack of coverage is not susceptible to change with an education or communication intervention

4. Have not participated in a health-related market research study within the past six (6) months; this avoids participants who may confuse recent focus group content and purpose with the current one.

5. Speak English fluently and comprehensibly; each group must speak the same language and the budget allows enough groups for only one language. English is the most common language.

6. Have earned at least a high school diploma and at least half must have at least some college but not hold a doctoral degree Each group is too small to include relatively rare subcategories at the low and high levels of education.

Each of the three groups will be relatively homogeneous on age, to maximize mutual communication from similar life stages. Specifically, a separate group each will contain only mothers who are ages:

• 25-34;

• 35-44; and

• 44-55.

Public reporting burden of this collection of information is estimated to average 10 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. 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0798).

Collectively, the geographic, gender, and racial/ethnic mix of the 24 participants will be diverse. Within each group (to the extent feasible) participants will come from:

• Men and women (4 of each);

• All regions of the U.S. (West, Midwest, East, North, and South);

• Urban (3), suburban (3), and rural (2) settings; and

• Hispanic American (2), African American (2), and Caucasian/ other (4) racial/ethnic groups. These are the three largest categories of the U.S. population; each group is too small to include less populated categories.

Form Approved

OMB No. 0920-0798

Exp: 01/31/2011

2-4: Screening instrument:

healthy adults focus groups

Hello. My name is __________________ and I am calling from _______________, a market research firm. We are talking today with people in the area about a public health issue. We are not selling anything.

ASK TO SPEAK TO AN ADULT IN THE HOUSEHOLD. WHEN HE OR SHE IS ON THE PHONE, REPEAT ABOVE INTRODUCTION IF NECESSARY.

IF CONTINUING FROM THE MOTHERS OF YOUNG CHILDREN SCREENER AND DISQUALIFIED AT…

Q7 (MALE) SKIP TO Q8

Q9 (NO CHILDREN) SKIP TO Q16

1. Are you, or is anyone in your household, a doctor, nurse, or other healthcare professional?

01 Yes (THANK AND TERMINATE)

02 No (CONTINUE)

2. Are you, or is anyone in your household, trained as a biological or medical researcher?

01 Yes (THANK AND TERMINATE)

02 No (CONTINUE)

3. Have you or anyone in your household ever worked for any of the following?

01 Advertising, public relations and/or market research

Public reporting burden of this collection of information is estimated to average 10 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. 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0798).

02 Any form of news media – TV, radio, newspaper, magazine, or Internet

03 A health clinic, doctor or dentist’s office, hospital, medical laboratory or

research institution, health insurance company or agency, pharmacy,

pharmaceutical company, or public health organization

04 Other health related field

(THANK AND TERMINATE IF YES TO ANY)

4. Have you ever participated in a focus group, or been paid to participate in a discussion group or interview?

____ Yes (CONTINUE)

____ No (SKIP TO Q.22)

5. What was that focus group, discussion, or interview about?

____________________________________

IF TOPIC WAS NOT HEALTH OR MEDICAL: GO TO Q.7

IF TOPIC WAS HEALTH OR MEDICAL: GO TO Q. 6

6. About how long ago was that?

_____________________________________

IF LESS THAN 1 YEAR THANK AND TERMINATE

7. Document Gender

01 Male (RECRUIT 4 PER GROUP)

02 Female (RECRUIT 4 PER GROUP)

8. How old are you? ______________

01 Under 25 (THANK AND TERMINATE)

02 25 - 34 (RECRUIT 8 FOR GROUP 1)

03 35-44 (RECRUIT 8 FOR GROUP 2)

4. 45 – 55 (RECRUIT FOR GROUP 3)

8b. Which of the following statements best describes the highest level of education you have completed?

(READ LIST; AT LEAST HALF MUST HAVE SOME COLLEGE OR MORE)

I did not graduate from high school 1 (THANK & TERMINATE)

I am a high school graduate 2 (RECORD & CONTINUE)

I took some trade school, junior college, community college or college classes but did not graduate 3 (RECORD & CONTINUE)

I am a trade school graduate 4 (RECORD & CONTINUE)

I graduated from a junior college or a community college 5 (RECORD & CONTINUE)

I graduated from a 4-year college 6 (RECORD & CONTINUE)

I have taken post-graduate courses, but do not have a post-graduate degree …..……… 7 (RECORD & CONTINUE)

I have a master’s degree .………..8 (LIMIT 2 PER GROUP; NO JDs)

I have a doctoral degree 9 (THANK &TERMINATE)

9. ASK WOMEN ONLY – Are you currently pregnant (TERMINATE IF YES)

10. Who usually makes healthcare decisions for you?

01 Self (or self and partner together) (CONTINUE)

02 Someone else (THANK AND TERMINATE)

11. Do you have a weakened immune system or disease, such as severe asthma, that tends to lead from sniffles, coughing, or wheezing into a bacterial infection, such as pneumonia?

1. No (CONTINUE)

2. Yes (THANK AND TERMINATE)

12. When you have a new prescription filled for you which of the following statements best describes how much you do pay? (READ RESPONSES)

Nothing – a health plan pays all of it	1	CONTINUE
You (or another family member or partner) pay part of it and a health plan pays the rest	2	CONTINUE
You (or another family member or partner) pay the entire cost of the medication	3	THANK & TERMINATE

[THE CRITICAL FACTOR HERE IS THAT THEY HAVE PRESCRIPTION DRUG COVERAGE; IF THE CAREGIVER OR ANOTHER PERSON IS PAYING THE OUT-OF-POCKETS FOR THE PATIENT, THEY STILL QUALIFY.]

13. How would you describe the geographic area where you live? Is it a...

(RECRUIT A MIX)

1. Rural area (Recruit 1-2)

2. Small city or town (Recruit 1-2

3. Suburb (Recruit 2-3)

4. Large city (Recruit 2-3)

14. Which of the following best describes your race or ethnicity?

01 American Indian or Alaska Native

02 Asian

03 Black or African American

04 Hispanic or Latina

05 Native Hawaiian or Other Pacific Islander

06 White

15. In your opinion, what is the biggest problem in American healthcare today?

[RECORD EXACT RESPONSE. Participants must be articulate, fluent in English, and willing to converse. If respondent has a strong accent, difficulty speaking English, serious speech impediment or has trouble communicating (e.g., “shuts down,” thank and terminate.]

16. We would like you to participate in a confidential telephone discussion group with other moms like you all over the country to talk about some health issues. It will take no more than 90 minutes and we’ll pay you or your favorite charity $50. All you’ll need is a land line phone to take this call. The session will include reading some short materials and then discussing them. Are you comfortable reading written materials?

01 Yes [CONTINUE]

02 No [THANK AND TERMINATE]

17. Since these discussions take place over the phone, you can participate from your home, your office, or anywhere else you need to be. All that we ask is that you participate from a regular telephone, not a cell phone. A conference operator will call you at the number of your choice. When everyone is on the line, a discussion leader will introduce everyone by first name only, and will then lead the group through several topics.

[ENTHUSIASTICALLY] Will you be able to join us on [DAY, DATE] at [CONVERT TIME INTO PARTICIPANT’S LOCAL TIME]?

01 Yes [CONTINUE]

02 No [THANK AND TERMINATE]

IF NECESSARY, EXPLAIN THAT THE DISCUSSION IS NOT A SALES PITCH.

(SCHEDULE DATE/TIME WHEN INTERVIEWEE AND INTERVIEWER ARE AVAILABLE)

Group 1 (Age 25-34) – Day, Date, Time

Group 2 (Age 35-44)– Day, Date, Time

Group 3 (Age 45-55) – Day, Date, Time

18. At what phone number shall we call you then? _________________________

19. We will send you a confirmation e-mail in a few days and a reminder of your interview time a few days before the interview. May we please have the following contact information?

INTERVIEWEE’S NAME: ______________________________________________________

E-MAIL ADDRESS: ___________________________________________________________

STREET ADDRESS: ___________________________________________________________

CITY: __________________________, STATE: __________ ZIP: ________________

HOME PHONE: ________________________________

WORK PHONE: ________________________________

Thank you very much—you should receive our materials shortly

16

Attachment 2 – Specifications and Screeners