2 Final Consumer Screener

Form Approved

OMB No. 0920-0800
Expiration Date: 1/31/2012

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

Inside Knowledge: Get the Facts About Gynecologic Cancer

2009 Focus Groups with Women, ages 40-60

Recruitment Screener for General Population Women

GROUP DATE/TIME:_________________________________________________________

Name:________________________________________________________________________

Phone # +/or e-mail address for confirmation: ______________________________________

_______________________________________________________________________________

Address:

City, State: _____________________________________ZIP Code:

Public reporting burden for this collection of information is estimated to average 3 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 Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0800).

Hello, my name is I’m with , a local public opinion research company. Today, we are working on a study to learn more about what women have heard about certain types of cancer. The research is sponsored by the Centers for Disease Control and Prevention, or CDC – part of the public health service – and will be used to plan new health education materials. I want to assure you that this is strictly about women’s ideas and opinions. There are no medical tests or procedures, or medications. And none of the ideas or opinions women provide will be used afterwards to try to sell anything. Some of the women I talk with may be invited to participate in another part of the opinion study. May I ask you a few questions today?

NOTE: Participants must be able to understand English well and speak English clearly enough for audiotapes to be transcribed -- please listen carefully during recruitment calls to make sure that anyone recruited can understand English and also speak clearly and loudly enough to participate well in English.

1. Are you currently employed? (CONTINUE for all -- Recruit a mix)

 

1 No

2 Yes, part time

3 Yes, full time

 

(If yes...) What type of work do you do? ______________

 

2. Have you or your spouse ever worked or volunteered for any of the following types of

organizations?

1. Doctor’s office, hospital, clinic, pharmaceutical or drug company

2. Health department or community health agency

3. Marketing research, advertising, or public relations agency or department

4. Centers for Disease Control and Prevention (“C-D-C”) or the National Institutes of Health (“N-I-H”)

5. An organization that focuses on cancer such as the American Cancer Society or another cancer-related organization

If yes to any:

Please find out what type(s) of paid or volunteer positions and whether position was held by respondent and/or spouse: _______________________________________________________________

[Terminate if prospective participant is obviously a health professional such as doctor or nurse. Otherwise, continue screening.]

3. For this study, I need to ask your age [IMPORTANT: please fill in exact age]: ________

If this age is:

1 Under 40 years old [Terminate]

Recruit a broad mix of women ages 40-60

2 Age 41 - 45

3 Age 46 - 50

4 Age 51 - 55

5 Age 56 - 60

4. Age 61+ [Terminate]

4. Do you have any kind of health insurance to pay for routine health care?

1 Yes

2 No

3 Don’t know

5. When was the last time you had a Pap test? You may have heard it called a Pap smear -

It’s the same thing. [PLEASE RECORD YEAR: __________]

1. 2008 or 2009

2. 2005, 2006, 2007

3. Before 2005

4. Don’t remember

5. Never

5a. Have you ever been told that you had an abnormal Pap result?

1 Yes 2 No

6.a. Have you ever been told by a doctor that you have any type of cancer?

1 No [Continue]

2 Yes: What type(s)? ______________________________________

Terminate all except basal cell or squamous cell skin cancer. If “skin cancer” is mentioned without specifying type, ask if it was “melanoma”. If yes, terminate. If no, continue screening.

6b. Have any of your close female relatives ever been diagnosed with cancer?

1 No [Continue]

2 Yes

If yes, ask:

Which relative(s), and what type(s) of cancer: ____________________________________________________________________

Terminate if any of the following (do not read list). Save all terminates.

Breast [Note: May eliminate from list if too many are being terminated.]

Cervical

Endometrial

Ovarian

Uterine

Vaginal

Vulvar

3 Don’t know [Continue]

7. Do you have any other relatives or any friends, male or female, who have had other types of cancer in the last 2-3 years?

1 No 2 Yes

If yes, ask whether friend(s) or relative(s), which relative(s), and what type(s) of cancer:

__________________________________________________________________

8. What is the highest grade of school you completed? [Read list]

1 Less than high school

2 High school or GED

3 Two year college or technical school

4 More than two years of college, but less than 4

5 4-year college degree

6 Post-graduate degree

9a. Please stop me when I read the range that includes your total household income before

taxes each year. This information is not going to be shared with anyone.

[Note: Goal is to recruit a mix of low, middle, upper middle income – income ranges can be adjusted as needed for each city/facility. Must have some lower and middle income. ]

1. Less than or equal to $25,000 per year

2. More than $25,000, less than $40,000

3. More than $40,000 less than $65,000

4. More than $65,000, less than $100,000

5. More than $100,000

6 prefer not to answer

9b. How many people live in your household? _____________

[Q10b is to help give us context for income responses – to increase SES diversity. As noted, income categories should be adjusted as appropriate for each city.]

10. For statistical purposes, what is your marital status?

[Do not read response options.]

1. Single

2. Married

3. Separated

4. Divorced

5. Other

11. And do you have any daughters?

[If yes…] May I ask their ages? _________________________

12. How would you describe your ethnicity?

1 Hispanic or Latino

2 Not Hispanic or Latino

13. How would you describe your race?

1 White

2 African American or Black

3 Asian

4 American Indian or Alaska Native

5 Native Hawaiian or Other Pacific Islander

14. When, if ever, was the last time you participated in audience research, such as a focus group?

1. Have never participated [Continue]

2. Within the last 12 months: What was the topic? _____________________________

If related to cancer, terminate. Prefer not to take anyone with health-related focus group experience in the last year if possible. Save all terminates.

3. More than 12 months ago [Continue]

15. READING COMFORT:

I have one more question. Part of our study may involve some reading. Some people have vision or reading difficulties, so they may prefer to be considered for other studies we do instead. Are you comfortable with brief reading tasks or would you prefer to be contacted for another study that does not involve reading?

____Reading is OK.

16. INVITATION:

The project I am working on includes several small groups with about 9 women who will meet once for about an hour and a half to talk informally about what you have heard about certain types of cancer. The discussion will be at our office, which is easy to get to. You do not need any special skills to participate, although there will be some reading involved.

You will be offered $60 as a thank-you for your time and ideas.

We would like to invite you to be in a group on... [See schedule]

Are you available?

1. No [Thank and end call.] 2 Yes

Great…I will send you a confirmation letter with directions.

Please note that there is a small possibility that some of the women who are invited may not be needed, but that cannot be determined before everyone arrives. If this happens, everyone who has arrived on time will be paid, even if you are not asked to stay for the discussion. We thank everyone for understanding this possibility.

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