Form
Approved
OMB No. 0990-0281
Exp. Date XX/XX/XX12
PARTICIPANT RECRUITMENT SCREENER
Dates and times of focus group sessions: One set of groups (first city: Chicago) will be conducted Month X, 2010; the other set of groups (second city: Washington, DC, area) will be conducted Month X, 2010. The first group will begin in the late afternoon (e.g., 3:30-5:30 p.m.), and the second group will begin in the evening (e.g., 7-9 p.m.). (This assumes two groups per day.)
Length of focus group sessions: Each focus group will meet for no more than 2 hours.
Latinos/Hispanics: All focus group participants will be Latinos/Hispanics currently residing in the United States.
Total number of participants per focus group: Recruit 10 participants for each focus group. While all participants who show will be paid an honorarium, we will seat no more than 6-8 individuals per group.
Age: All focus group participants must be between the ages of 18 and 65 years.
Gender: Each focus group must strive for an equal proportion of women and men (half women/half men).
Education level: DO NOT RECRUIT ANYONE WITH AN EDUCATIONAL DEGREE HIGHER THAN HIGH SCHOOL.
Income level: DO NOT RECRUIT ANYONE WITH AN ANNUAL TOTAL HOUSEHOLD INCOME OF MORE THAN $40,000.
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 0990-0281. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer
Internet use: Recruit only participants who have not searched the Internet for health information in the past year (12 months).
Spanish language: All participants must be 100-percent fluent in Spanish and be comfortable with a focus group discussion conducted entirely in Spanish. All participants must also be comfortable writing short responses to several questions on a piece of paper.
Countries of origin: For each focus group, strive to reach this composition:
Two participants of Mexican ancestry
Two participants of Central American ancestry
Two participants of South American ancestry
Two participants of Caribbean ancestry (e.g., Cuban, Puerto Rican, Dominican)
Profession: Do not recruit anyone in the health care profession.
Family members: Recruit only one individual per family. In other words, two members of the same nuclear family (e.g., siblings, or parent and child) cannot be recruited. Extended family members (e.g., cousins) may be recruited as a last resort; if this occurs, schedule such family members for different focus group discussion sessions.
Hello, my name is ____________________. I’m calling from a health research organization concerned about the health of Latino people. A Government organization is going to be creating a new Spanish-language Web site. This Web site will focus on disease prevention and health promotion. We’d like to test the Web site with a small group of Latinos to learn what you would like in such a Web site. I want to assure you that we are not selling anything and that research participant responses will be kept strictly confidential. Would you be interested in participating in such a discussion group? We would pay you for your time. May I first ask you a few questions to see if you would qualify to participate in this research project? (This will only take a few minutes of your time.)
Check whether respondent is: _____ Male or _____ Female
Q1. Are you between the ages of 18 and 65 years?
_____ Yes
What is your age? _____
_____ No [THANK AND TERMINATE CALL.]
Q2. What is your line of work?
________________________________________
[SCREEN OUT ANYONE IN THE HEALTH CARE PROFESSION.]
Q3. Are you Latino/Hispanic?
_____ Yes
_____ No [THANK AND TERMINATE CALL.]
Please specify your country of origin:
_____ Mexico
[RECRUIT TWO INDIVIDUALS PER GROUP.]
_____ Central America (Specify country): ________________________________
[RECRUIT TWO INDIVIDUALS PER GROUP.]
_____ South America (Specify country): ___________________________________
[RECRUIT TWO INDIVIDUALS PER GROUP.]
_____ Caribbean
(Specify country: Puerto Rico, Dominican Republic, Cuba, other: _______________)
[RECRUIT TWO INDIVIDUALS PER GROUP.]
With which of the following categories do you identify?
_____ White/Caucasian
_____ African American/Black
_____ Asian/Asian American
_____ American Indian/Native American
_____ Alaska Native
_____ Indigenous
_____ Other (Please specify: _______________________________________)
Q4. What is the highest level of education that you have completed?
_____ Less than high school
_____ Completed high school
_____ Some college/university [THANK AND TERMINATE CALL.]
_____ Some technical school [THANK AND TERMINATE CALL.]
_____ Completed college/university/technical school [THANK AND TERMINATE CALL.]
_____ Any degree after college (i.e., a graduate degree: Master’s, Doctorate, Medical Doctor, Doctor of Jurisprudence) [THANK AND TERMINATE CALL.]
[DO NOT RECRUIT ANYONE WITH ANY EDUCATION BEYOND HIGH SCHOOL.]
Q5. What was the total annual income of your household last year, before taxes:
_____ Less than $20,000
_____ $20,001 to $40,000
_____ $40,001 to $70,000 [THANK AND TERMINATE CALL.]
_____ $70,001 to $100,000 [THANK AND TERMINATE CALL.]
_____ More than $100,000 [THANK AND TERMINATE CALL.]
Q6. Do you ever use the Internet/World Wide Web?
_____ Yes
_____ No [THANK AND TERMINATE CALL.]
Q7. How often in the past year (12 months) did you search the Internet for “health” information? (Even if someone else helped you with this search.)
_____Not at all
_____Infrequently/once every few months
_____Once a month [THANK AND TERMINATE CALL.]
_____Once or more a week [THANK AND TERMINATE CALL.]
Q8. What language do you primarily speak at home?
_____ English
_____ Spanish
Q9. What language do you primarily speak outside your home?
_____ English
_____ Spanish
Q10. How fluent do you consider yourself to be in English and in Spanish?
_____ Fluent in English, but not in Spanish [THANK AND TERMINATE CALL.]
_____ Fluent in Spanish, but not in English
_____ Fluent in both English and Spanish
Q11. The group discussion (“focus group”) in which we would like you to participate will be about health-related issues and will be conducted all in Spanish. Are you comfortable speaking only in Spanish during the entire discussion?
_____ Yes
_____ No [THANK AND TERMINATE CALL.]
Q12. Are you comfortable writing short answers to questions on a piece of paper in SPANISH?
_____ Yes
_____ No [THANK AND TERMINATE CALL.]
INVITATION
As I stated earlier, we are conducting research with Latino adults to test a new Spanish-language Web site related to disease prevention and health promotion. We would like to invite you to participate in a small group conversation consisting of about 6-8 adults and a discussion facilitator. Your opinions will be very important to our research, as we would like to create a Web site that will truly be meaningful to people like you.
This is not a sales meeting. No one will try to sell you anything, and we want to assure you that your responses will be kept confidential. The discussion will last no more than 2 hours (120 minutes). We will give you $75 for your participation. Light food and refreshments will be served.
The discussion will be held at LOCATION on DATE AND TIME. (Provide directions and parking instructions if necessary).
Do you think you will be able to attend? _____ Yes _____ No
Thank you very much for accepting our invitation.
If you use glasses for reading, please bring them.
It is very important that you arrive on time. If, for any reason, you have to cancel, please call us at ___-___-____ so we can find someone to attend in your place.
May I verify the correct spelling of your name, address, and telephone number for a confirmation and reminder call the day before your discussion session and/or for a reminder and confirmation letter (containing the name and address of the focus group facility, date and time of the focus group, generic purpose of the focus group, map, directions, parking and public transportation information, food to be provided, etc.)?
Name ________________________________________________________________________
Address _____________________________________________ ZIP Code _____________
Home Phone _____________ Work Phone ________________ Cell Phone ________________
Email ________________________________________________________________________
| File Type | application/msword |
| Author | wt45 |
| Last Modified By | Administrator |
| File Modified | 2010-04-22 |
| File Created | 2010-04-22 |