Various Pretesting Activities (see attached list)

MODERATOR’S GUIDE FOR FOCUS GROUP INTERVIEWS ABOUT THE SPECIAL SWORN STATUS FORM COMPLETED BY HEALTH CARE PROVIDERS FOR THE NATIONAL IMMUNIZATION SURVEY

I. Introduction

Good evening and thank you all for coming. We are here to talk about some new procedures for conducting the National Immunization Survey. Before we start, I want to give you some general or background information about the survey.

It is conducted by the Centers for Disease Control and Prevention to collect up-to-date information on current vaccination levels for preschool children in each state. To do this, a sample of households is contacted and telephone interviews are conducted among parents or guardians of children in the eligible age ranges. They are asked about their children’s immunization history and are asked for permission to contact their child’s health care provider for specific information about the types of vaccines the child received and when the vaccines were received. After that, health care providers who are named by the parents or guardians are contacted and asked to complete an Immunization History Questionnaire for the child.

Today, we are going to be talking about some of those forms that you, as health care providers, may be filling out if your practice participates in this survey. We want your feedback on these forms and some changes to the survey that have to do with your role in it.

Are there any questions before we begin?

II. Response Process

How many of you have completed the Immunization History Questionnaire before? [SHOW THE QUESTIONNAIRE TO THE GROUP]

A. For participants who have completed surveys before:

Do you remember how the procedures worked in your office?

Who made the decision to complete the forms?

How many people were involved in filling out the forms?

Have you completed the forms every time you’ve received them? If no, why not?

Did you think filling out the forms was a worthwhile thing to do or not a worthwhile thing to do? Why?

B. For participants who have not completed surveys before:

Has your office ever been asked to complete these questionnaires before?

If yes, why do you think your office did not complete them?

If yes, who normally would complete these types of forms?

Do you think your office would complete the forms in the future, if your office were to receive them?

Would you yourself be completing the forms in the future?

III. Purpose of the focus group

As we mentioned earlier, we’re here today because the Census Bureau is conducting a special study to measure a new methodology that may improve the coverage of eligible children. Unlike the current procedures, health care providers will now receive a new mailing that will ask them to sign a new form. This new form is part of the Census Bureau’s rules for maintaining the confidentiality of the information it collects. During this discussion, we want you to give your opinions about the materials that will be included in this new mailing.

IV. Reaction to Content and Language of the Letter and SSS Form

I’m going to show you some of the items we send out in the mail. I’d like you to take a moment to read through these materials.

[HAND OUT ENVELOPES CONTAINING THE COVER LETTER, THE SSS FORM, QUESTIONNAIRE, AND THE INSERT; GIVE PARTICIPANTS A CHANCE TO LOOK THEM OVER]

[TRY TO OBSERVE PARTICIPANTS’ BEHAVIOR. DO THEY GO BACK AND FORTH FROM LETTER TO FORM TO SEE HOW THEY ARE CONNECTED?]

What was your first reaction when you read the letter and the form? [What we’re particularly interested in is the content of the materials; we will talk about other types of reactions later.]

Let’s go over the items separately and we’ll start with the letter.

What was the main purpose of the letter, based on your understanding of it?

How much of the letter did you read?

Were there parts you spent more time on than others? If so, what were they?

Was it easy or hard to read? Why? [PROBE ABOUT BOTH THE “LOOK” AND LANGUAGE IN THE LETTER]

Where there any parts of the letter that would encourage you to help with the survey? If so, what were they?

Were there parts of the letter that might discourage you from helping with the survey? If so, what were they?

What about the SSS form?

What was the main purpose of the form, based on your understanding of it?

Were there parts that you spent more time on than others? If so, what were they?

Was the language easy to understand or difficult to understand?

Was it clear what you were supposed to do? If not, what wasn’t clear?

Is there anything on the form that might make you hesitant to fill it out? If so, what was it?

Can I get you to fill it out for me? [HAVE PARTICIPANTS COMPLETE THE FORM, IF POSSIBLE]

[If participants have questions about the language or structure of the form, get specific information about the source of their misunderstanding and suggestions they have for making it easier to understand]

Did you notice the Insert containing the explanation of the immunization survey special sworn status?

What was the main purpose of the Insert?

How much of it did you read?

Were there parts you spent more time on than others?

Did it help you understand the SSS form better? If so, how? If not, why?

Do you think you might use the Insert? If so, how? If not, why?

V. General Comments on SSS

Now we have some more general questions about some of the things we have been talking about.

The form that you filled out (show form if necessary) had the title, “Special Sworn Status”. What do you think of that title “Special Sworn Status”?

What do you think “Special Sworn Status” means?

What sorts of expectations do you think come along with having SSS?

What are your thoughts on those expectations?

Do those expectations bring to mind any questions or concerns about what they might mean for you?

If your office decides to participate in this study, who will have access to the Immunization Survey Questionnaire?

How many people is that?

Based on your understanding of Special Sworn Status, how many of those people should sign the Special Sworn Status form?

Everyone who will see or fill out the immunization questionnaire will need to sign this form.[PROBE DISCREPANCY BETWEEN PEOPLE WHO HAVE ACCESS AND PEOPLE WHO SIGN SSS FORM]

[if necessary] What can we do to this form and/or the letter to make that more clear?

Do you think staff in your office would be willing to fill out this SSS form? Why or why not?

What changes could we make to the SSS form to make it more likely that people in your office would sign it?

Would this requirement to complete this form make a difference in your office’s decision to participate in the National Immunization Survey?

[IF ANYONE MENTIONS THE HIPAA REQUIREMENTS, HAND OUT THE FAQs ABOUT HIPAA AND THE NIS; FIND OUT WHETHER THIS ANSWERS THEIR QUESTIONS]

VI. Overall Concerns about Participating in the Survey

These are some additional materials that will come with the intial mailing of the SSS form. [HAND OUT HIPAA FAQs IF YOU HAVE NOT ALREADY DONE SO and MMWR]

Would it be helpful to have this additional information in the envelope?

Would the information about how Special Sworn Status relates to HIPAA be helpful?

Would the informational material about how the survey results are used be helpful?

What other kind of information would be useful to you to include in the initial mailing?

What else, if anything, would you like to see that might increase your likelihood of signing the SSS form?

Now thinking about all of the materials in this envelope [HOLD UP A STUFFED ENVELOPE FOR Ps TO SEE],what are your thoughts on getting it in the mail?

Is there anything in this envelope that you think doesn’t need to be there?

Is there anything in this envelope that would discourage your office from participating in the survey?

Do you have any other concerns about participating in the survey?

Do you have any suggestions for what might make it easier for you to respond to the survey?

Would you prefer submitting Immunization History Questionnaire electronically over the Internet, versus filling out paper forms and returning them by mail, if electronic submissions were possible? Why do you feel that way?

Which would be easier? Harder?

Which would require more time to do? Less time to do?

Which would be the least costly for you? The most costly for you?

VII. After the signed Special Sworn Status forms are received by the Census Bureau, a packet of materials will be mailed to you. The packet will contain a letter, indicating the names of the patients for whom immunization records are needed along with a signed permission form, indicating that permission has been received from the child’s parent/guardian for medical information to be released by the health provider. The permission forms may be signed electronically by Census Bureau staff when permission is received during a telephone interview with the child’s parent/guardian or they may be signed directly by the parent/guardian.

Would it make any difference in your willingness to participate in the NIS if the consent forms were signed electronically? Signed directly?

If your office received permissions forms signed electronically, would you have any concerns regarding the authenticity of the permission if it were displayed in an electronic signature?

VIII. Final Question/Wrap-up

We have one final overall question. We’ve had a lot of discussion about things that might make a difference in your willingness to participate in the NIS.

Other than anything we’ve already talked about, is there anything else that we could say or do that would increase your chances of participating in the NIS? What would make your office more likely to respond?