Form 1 video

Appendix 1: Online Survey Instrument

Form Approval

OMB No. 0925-0585-05

Expires 02/28/2011

Online Survey Screener and Guide

Public reporting burden for this collection of information is estimated to average 25 minutes per response. This time includes the length of time allotted for the survey questions. 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.

PART 1: Screening

Please use the following language for termination of screening:

“Thank you very much for your time today. We are looking to recruit a mix of people from a variety of backgrounds to help with this study. Right now we have enough people with your type of background. Again, thank you.”

For this project, it is important that individuals from a variety of races, ethnicities, genders and sexual orientations complete this survey. The next few questions will determine if you are among the people we are still recruiting.

Your answers will not be connected to you and you will not be asked to share your name. You do not have to answer questions that you don’t want to. You may stop at any time. The National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health, is the sponsor of this project.

1. Which of the following best describes your gender?

1 Female (Recruit for Female Groups Only) Skip to Q5

2 Male (Recruit for Heterosexual Male or MSM Groups) Skip to Q7

3 Transgender (Recruit for Transgender Groups Only) Continue to Q2

4 OTHER OR REFUSED TERMINATE

TRANSGENDER ONLY

2. Are you M2F/MTF (male to female) or F2M/FTM (female to male)?

1 Male to female M2F/MTF Continue

2 Female to male F2M/FTM TERM

3 REFUSED TERM

3. Have you had sex with a man during the past year?

 

A Yes Continue

B No TERM

C Don’t Know/Not Sure/Refused TERM

4. Please indicate your ethnicity and race.

Ethnicity:

1 Hispanic or Latino Continue

2 Not Hispanic or Latino Continue

3 REFUSED TERM

Race:

1 American Indian or Alaska Native Continue

2 Asian Continue

3 Black or African American Continue

4 Native Hawaiian or Other Pacific Islander Continue

5 White Continue

6 REFUSED TERM

[Those that indicated “Hispanic or Latino” ethnicity should be asked Q4a after responding to the race question. Those that indicated “Not Hispanic or Latino” ethnicity should be asked Q10 after responding to the race question.]

4a. [Ask ONLY of Hispanic/Latino respondents] What language do you mainly speak at home?

1 English Continue to Q10

2 Spanish Continue to Q10

3 Both English and Spanish Continue to Q10

4 Other TERM

FEMALE GENDER ONLY

5. Have you had sex with a man during the past year?

 

A Yes Continue

B No TERM

C Don’t Know/Not Sure/Refused TERM

6. Please indicate your ethnicity and race.

Ethnicity:

1 Hispanic or Latino Continue

2 Not Hispanic or Latino Continue

3 REFUSED TERM

Race:

1 American Indian or Alaska Native Continue

2 Asian Continue

3 Black or African American Continue

4 Native Hawaiian or Other Pacific Islander Continue

5 White Continue

6 REFUSED TERM

[Those that indicated “Hispanic or Latino” ethnicity should be asked Q6a after responding to the race question. Those that indicated “Not Hispanic or Latino” ethnicity should be asked Q10 after responding to the race question.]

6a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?

1 English Continue to Q10

2 Spanish Continue to Q10

3 Both English and Spanish Continue to Q10

4 Other TERM

MALE GENDER ONLY

7. Have you had sex with a man during the past year?

 

A Yes Continue

B No Skip to Q9

C Don’t Know/Not Sure/Refused TERM

MSM ONLY

8. Please indicate your ethnicity and race.

Ethnicity:

1 Hispanic or Latino Continue

2 Not Hispanic or Latino Continue

3 REFUSED TERM

Race:

1 American Indian or Alaska Native Continue

2 Asian Continue

3 Black or African American Continue

4 Native Hawaiian or Other Pacific Islander Continue

5 White Continue

6 REFUSED TERM

[Those that indicated “Hispanic or Latino” ethnicity should be asked Q8a after responding to the race question. Those that indicated “Not Hispanic or Latino” ethnicity should be asked Q10 after responding to the race question.]

8a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?

1 English Continue to Q10

2 Spanish Continue to Q10

3 Both English and Spanish Continue to Q10

4 Other TERM

HETEROSEXUAL MALE ONLY

9. Please indicate your ethnicity and race.

Ethnicity:

1 Hispanic or Latino Continue

2 Not Hispanic or Latino Continue

3 REFUSED TERM

Race:

1 American Indian or Alaska Native Continue

2 Asian Continue

3 Black or African American Continue

4 Native Hawaiian or Other Pacific Islander Continue

5 White Continue

6 REFUSED TERM

[Those that indicated “Hispanic or Latino” ethnicity should be asked Q9a after responding to the race question. Those that indicated “Not Hispanic or Latino” ethnicity should be asked Q10 after responding to the race question.]

9a. [Ask ONLY of Hispanic respondents] What language do you mainly speak at home?

1 English Continue to Q10

2 Spanish Continue to Q10

3 Both English and Spanish Continue to Q10

4 Other TERM

FOR ALL GROUPS

OK, just a few more questions for our records.

10. Please tell me your age.

(Record actual age) ___________________

Recruit half above and half below age 35 for each audience.

Terminate minors.

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

1 Less than $X Continue

2 $X or more Continue

3 DK/REF TERM

Please use X as listed below.

African Americans: $34,218

Hispanics/Latinos: $37,913

Caucasians: $55,530

Other race/ethnicity: $50,303

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

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

1 Plan to get GED or have not finished high school Continue

2 Completed high school or have GED Continue

3 Some college/technical training/associate’s degree Continue

4 Completed college Continue

5 Graduate degree (master’s or higher) Continue

6 DK/REF……………………………………………………………………………………...Continue

13. Are you comfortable reading and reviewing materials in English?

1 Yes Continue

2 NO/DK Thank and TERM

14. Are you now or have you ever participated in an HIV vaccine trial?

1 Yes (Continue)

2 No (Continue)

3 Don’t know (Continue)

Invitation and Informed Consent

Thank you for answering these initial questions.

You qualify to participate in the survey. The survey will last up to 20 more minutes. You are going to be shown some ideas for videos and one completed video about HIV vaccine research. You will be asked to share your opinions about them. Your feedback will be used to develop videos about HIV vaccine research. All of the feedback you provide will help us improve HIV vaccine research videos.

When you complete the survey, you will receive [incentive valuing $10] for your participation. You may choose not to answer any questions that make you uncomfortable or stop participation at any time, but to qualify for the [incentive valuing $10] you will need to answer every question on the survey.

This set of focus groups is authorized by the National Institutes of Health and the Public Health Service Act. The National Institutes of Health (NIH) is the sponsor of this project. The Academy for Educational Development (AED) is helping with the project. Your feedback will not be shared with anyone outside this project.

We will keep what you say private, except as otherwise required by law. Your responses will be entered into a database and will only be seen by researchers associated with this survey. Your answers will not be connected to you and your name or email address will not be recorded. There will be no risk to you.

15. Would you like to continue? Selecting “yes” means you agree with these terms.

1 Yes

2 No THANK AND TERM

First, you are going to see two videos.

Show first video. Allow participants to replay the video.

16. Is this message for someone like you, or do you think it is intended for someone else?

1 Someone like me

2 Someone else: Specify_________________

3 Not sure

17. How likely would this video be to catch your attention? Would you say it would be…

1 Very likely

2 Somewhat likely

3 Neither likely nor unlikely

4 Somewhat unlikely

5 Very unlikely

18. Do you trust the information in the video?

1 Completely believe it

2 Believe it somewhat

3 Neither believe it nor disbelieve it

4 Disbelieve it somewhat

5 Completely disbelieve it

19. Thinking about the speakers in the video, were there any speakers that you did not like? Select images of any/all speakers that you did not like.

1 Insert image of speaker

2 Insert image of speaker

3 Insert image of speaker

4 Insert image of speaker [Number to be adjusted after videos are selected]

19a. [For any speakers disliked] What makes you dislike this speaker? [Show image of speaker]

Repeat question if respondent selects multiple speakers, show images.

20. If you saw this on a website or TV, would you want to watch this video?

1 Yes

2 No

3 Not sure

Repeat for second video.

Now I will show you two ideas for videos about HIV vaccine research. Keep in mind that what you will see today are just examples of the script and drawings of the people and scenes that will be included. This is not the final version. The final versions will be full television productions with people and they might have background music or special effects.

Play story board. Alternate order.

21. Imagine you saw this video on television or on a Web site. How likely is it that you would pay attention?

1 Very likely

2 Somewhat likely

3 Neither likely nor unlikely

4 Somewhat unlikely

5 Very unlikely

22. Did anything strike you as distasteful or inappropriate?

1 Yes

2 No

3 Not sure

22a. [If yes] What did you find distasteful or inappropriate?

23. Is this video for someone like you, or do you think it is intended for someone else?

1 Someone like me

2 Someone else: Specify_________________

3 Not sure

24. Is the video trying to get you to do something?

1 Yes

2 No

3 Not sure

24a. [If yes] What is it trying to get you to do?

25. What would you change to make it better or more appealing to you?

Repeat for the other approach.

After both approaches have been reviewed.

26. If you had to pick one of these announcements, which one is more likely to make you interested in learning about HIV vaccine research? Participants must select ONE.

1 [Insert approach]

2 [Insert approach]

26a. Why do you prefer that approach?

27. What topics would you like to see included in a video about HIV vaccine research? Select all that apply.

1 What is in a vaccine used for HIV vaccine research?

2 What safety precautions are in place for HIV vaccine research?

3 Myths and misconceptions about HIV vaccine research

4 Ways to get involved

5 Reasons to support HIV vaccine research

6 Why I volunteered for HIV vaccine research [Testimonial from volunteer]

7 Why I’m proud of my family member/friend that volunteered for HIV vaccine research [Testimonial from family member or friend of person who volunteered]

8 Other: Specify_________________

28. After seeing announcements like these, how likely would you be to visit a Web site to learn more about HIV vaccine research?

1 Very likely

2 Somewhat likely

3 Neither likely nor unlikely

4 Somewhat unlikely

5 Very unlikely

Thank you very much for your time. Your feedback has been helpful.

If you’d like more information about HIV vaccine research, please visit: http://bethegeneration.nih.gov.

Appendix 1: Online Survey Instrument 9