Various Demographic Area Pretesting Activities

Affordable Care Act Pretesting

Recruitment Plan

Focus Groups 3 and 4

Recruiting Overview

In total there will be six focus groups, three each in Spanish and English, followed by 84 cognitive interviews with 42 in Spanish and 42 in English. The focus groups will be conducted in three rounds, each with one English and one Spanish group as follows: Group 1 (Spanish, RSS – Boston Mass), Group 2 (English, RSS – Boston), Group 3 (English, CSR – Central Mass), Group 4 (Spanish, RSS – Lowell/Lawrence), ^{Group 5 (Spanish, RSS – Springfield/Ludlow), and Group 6 (English, CSR – Boston). Cognitive interviews will} be conducted over four rounds.

Recruitment and interviewing of one third of the cognitive respondents will take place outside of the Boston area – including Western Mass and Central Mass for English speakers and Springfield, Fall River/New Bedford or Lawrence/Lowell/Ludlow (for Spanish speakers). This will provide a range of responses from diverse urban and rural areas of the state.

We are working under the assumption that we will be granted access to the Massachusetts Connector Database to identify potential respondents for focus groups 5-6 and for all cognitive interviews. However, we are not yet sure of what kind of access we will have. Therefore, we will need to submit a recruitment plan specific to those efforts once these issues are clarified.

Recruitment Procedures for Focus Group 3 & 4

For the focus groups, we plan to use traditionally effective recruiting methods, as discussed below.

Outreach

Flyers will be posted on community boards in local grocery stores, libraries, and health clinics, ESL schools and with community organizations . We may place an ad in the Fitchburg Sentinel (local newspaper) for English participants. Ads will be placed in Spanish language newspapers to recruit Spanish speaking participants. Recruiting through online resources such as Craigslist.com, backpage.com and other online sites may be used to generate calls from potential English speaking participants, however, the screener will include questions about previous focus group participation. Spanish Language online resources are more limited but may also used as available. All flyers and ads will ask potential participants to call in to an 800 number. Someone will call them back to screen them for eligibility

Goals

Our goal is to have 10-11 participants per focus group, with a maximum of 15 and a minimum of 8. With this aim, we will strive to identify and recruit 15 participants per group with the expectation that there will be last minute cancellations or no-shows (despite reminder calls), as our experience suggests. By recruiting the maximum number, we anticipate that (barring extreme weather), we will meet the minimum targets. Should more than 11 participants be present at the time the focus group begins, the additional persons will be paid and dismissed, as larger groups do not foster good discussion.

Participant Characteristics

For these Focus Groups, our aim is to have several participants who got their insurance through Commonwealth Care. We will also focus on getting respondents who have gotten their health insurance through the Health Connector, or, at the very least those who have had contact with or know of it. Screening and advertising efforts will be focused to these goals. However, for the Spanish Language Focus Group we anticipate that achieving these goals will be difficult. We will keep the Census team apprised of our success and will include them in any modifications needed to achieve our minimum target. In addition, we will attempt to meet demographic and household characteristics laid out in the RFP. We will screen and strive to achieve a balance across the following characteristics:

AGE

• Individuals who are aged 18-34

• Individuals who are aged 35-60

• Individuals who are aged 61-64

GENDER

EDUCATION

• Those with a BA or higher

• Those with less than a BA

We will also screen for the following characteristics:

PARENTS OF DEPENDENT CHILDREN AGE 17 or YOUNGER (yes/no)

MARITAL STATUS (married or not)

INCOME LEVEL

We hope to be able to have a good representation of different income levels, including lower middle class individuals (family income between 250 and 300 percent of the FPL). From experience, we know that it is almost impossible to accurately screen for family income in a telephone screener without asking a much longer battery of questions. Our goal will be to get a heterogeneous sample with regards to income-to-poverty levels.

The recruitment screener will ask for native language. In an effort to have ethnic diversity among English speakers within the constraints of achieving demographic characteristics and the targets listed above, English speakers whose native language is not English will be considered for cognitive interviews if they self-report they speak English at least well. For focus groups, however, we will only accept those who speak English at least very well (regardless of place of birth), so that we have articulate respondents who can express their thoughts freely.

Screening Procedures

Once contact is made with a potential participant, the recruiter will screen candidates for eligibility using a scripted series of questions developed as part of the recruiting plan and approved by the Census Bureau. For English speaking participants, Focus Group invitations will not be offered immediately after the screener is completed. In order to better control who is in the group, possible participants will be invited only after looking at various characteristics and choosing who would best meet our needs in the group. Because we anticipate significantly more difficulty in recruiting Spanish monolingual participants, qualified individuals will be issued invitations upon completion of the screener. Once we are confident that we can meet the minimum of eight participants, additional demographic criteria will be used to select the final participants.

Reminder Calls & Mail Confirmations

If time permits, the respondent will receive by mail or email a confirmation of the time and place, with directions. We will make reminder calls the day before the focus group to confirm Focus Group time and venue. Participants will be offered a $75 cash incentive for participation in a focus group.

Minimizing bias while screening.

Screening for health insurance status introduces the risk of increasing the participant’s awareness of the very facts we wish to test in the focus groups. In later rounds, one major benefit of using the Connector data is that screening will be significantly reduced because we will already have information from the database about the type and access point of insurance coverage for each individual. In these Focus Groups it will not be possible to avoid ^{drawing attention to the health insurance status of participants during screening since it is necessary to specifically screen for knowledge and use of the Health Connector and the exchange system in Massachusetts.}

Recruiting and Screening Materials

^{Title 13 Protection. Because the recruiting information collected about the participants will be protected by Title 13, recruitment screeners and records of calls with PII information will be maintained solely on paper forms and sent to the Census Bureau in via Federal Express at the end of the project. In addition, spreadsheets will be maintained tracking recruitment progress throughout the project using non-identifying participant ID numbers and non-PII information about the recruitment efforts and target priorities (i.e., age will be a non-specific range).}

To ensure effective recruiting, we shall use several materials, as follows:

Recruitment Flyer/Online Advertisement

A standard text for ads will be used with specific subject headers based on target needs. Examples will be provided and approved by census prior to use. Flyers approved for the first round of focus groups will be used again and additional flyers may be submitted for approval. An examples of first round flyer is in Appendix A.

Screener:

A standard screener will be used by recruiters to determine eligibility to participate in the first two focus groups. The English version of the screener submitted for approval is in Appendix B.

Recruitment Log: This is an electronic form for use by RSS-CSR to keep track of scheduled focus groups and cognitive testing interviews. Potential respondents will be identified by an ID only and it will not contain any Title 13 data. It keeps track of the basic demographics of the respondents and answers to key screening questions during; respondents will be identified by ID only

Appendix A

The Center for Survey Research (CSR) at the University of Massachusetts Boston and Research Support Services Inc. (RSS) are working with the

U.S. Census Bureau to find out about health insurance in Massachusetts since 2006.

You may be eligible to earn $75 by participating in a group discussion

 

Who: Adults who have the Double C symbol on their health insurance card or who have signed up for insurance through the Health Connector.

What: A group discussion that lasts about 2 hours. You will be

paid $75 after the discussion to thank you for your time.

When: Thursday, January 12

Where: Fitchburg State University

 

If you are interested: Please call our message line at 1-877-302-9278. Leave your name, phone number, and a good time to reach you. Someone will call back to ask you a few questions to see if you are eligible.

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

January 12^th

Group discussion $75

1-877-302-9278

Appendix B

Affordable Care Focus Group (Round 2) English Screener 12/28/11

Thank you for your interest in this project. Let me tell you a little about it and then I have to ask you a few questions to see if you qualify. I work for (Research Support Services, Inc. (RSS)/the Center for Survey Research at UMass Boston), we are conducting a study for the U.S. Census Bureau to help them understand how people think about health insurance and coverage. We will be having a focus group about these topics, but we won’t be asking any questions about medical conditions or about your health.

A focus group is a group discussion between a research professional called a moderator and a small group of people, about 10, who have been pre-selected. The focus groups last about two hours. We make a videotape of the focus group so we can have the project team review it for their research. But all information you provide is confidential and protected by law so it cannot be released to anyone outside the research team. If you do qualify and agree to participate, it is very important that you don’t cancel since only a limited number of people are invited. Do you have a few minutes for me to ask you the questions now? (IF YES, PROCEED. IF NOT, ARRANGE FOR CALLBACK)

Availability:

Are you available for a focus group on (FILL DATE)

[ ] Yes

[ ] No  (IF UNABLE TO MAKE THE TIME, EXPLAIN THAT THEY DO NOT QUALIFY FOR THIS FOCUS GROUP BUT WE CAN CONTINUE WITH THE SCREENER TO SEE IF THEY QUALIFY FOR FUTURE PORTIONS OF THE PROJECT NEXT YEAR)

[ ] Maybe

1. Your Name______________

2. How old are you? ___________
   
   

3. Are you male or female?:___________
   
   

4. Are you of Hispanic, Latino or of Spanish origin? YES NO

5. I am going to read a list of race categories. Please choose one or more races that you consider yourself to be: White; Black or African American; American Indian or Alaska Native; Asian; Or Native Hawaiian or Other Pacific Islander.

[ ] White

[ ] Black or African American

[ ] American Indian or Alaska native

[ ] Asian

[ ] Native Hawaiian or Other Pacific Islander

6. Are you currently married? YES NO

7. What is the highest level of education you have completed? (INCLUDE EQUIVALENT EDUCATION LEVEL IN OTHER COUNTRIES)

[ ] 8^th grade or less

[ ] Some high school but did not graduate

[ ] High school graduate or GED

[ ] Some college or 2-year degree

[ ] 4-year college graduate

[ ] More than 4-year college degree

8. Is English your native language?
   [ ] YES  In what country were you born?: ________________

[ ] NO  What is your native (primary) language?________________________

How well do you speak English? Would you say: very well, well, not well, or not at all?

Very well

Well

Not very well  Skip to END do not schedule for English group

Not at all  Skip to END do not schedule for English group

9. Do you currently have health insurance coverage?

[ ] Yes

[ ] No (SKIP TO Q17)

10. What kind of health insurance do you have?

[ ] Blue Cross/Blue Shield

[ ] Boston Medical Center (BMC) Healthnet

[ ] Celticare

[ ] Fallon Community Health Plan

[ ] Harvard Pilgrim Health Care

[ ] Network Health

[ ] Neighborhood Health Plan

[ ] Tufts Health Plan

[ ] MassHealth (SKIP TO Q16x)

[ ] Other: ____________________________________

11. Are you currently working?

[ ] Yes

[ ] No (SKIP TO Q13)

12. Do you get your health insurance through your employer?

[ ] Yes (SKIP TO Q14x)

[ ] No

13. Is your insurance through MassHealth?

[ ] Yes (SKIP TO Q14x)

[ ] No

[ ] DK

14. Is your insurance through Commonwealth Choice (COMMCHOICE), Commonwealth Care (COMMCARE) or something else?

[ ] CommChoice

[ ] CommCare

[ ] Commonwealth Care Bridge

[ ] SOMETHING ELSE (SPECIFY) _____________

[ ] DON’T KNOW

14x. On your health insurance card check on the top right corner, could you describe the logo/picture you see there?

LOGO IS THE DOUBLE C NOT THE SURROUNDING PORTION--

[ ] COMCARE/COMCHOICE/COMBRIDGE LOGO PRESENT (SKIP TO Q20)

[ ] none/not double C

[ ] DOESN’T HAVE CARD (SKIP TO Q20)

14Y. On the bottom Right, could you tell me if it lists a plan name/What is it?

[ ] COMCARE/COMCHOICE/COMBRIDGE PRESENT (SKIP TO Q20)

[ ] none/not double C

15. Have you ever gotten health insurance through Commonwealth Choice (COMMCHOICE), Commonwealth Care (COMMCARE) or Commonwealth Care Bridge?

[ ] Yes - Which program did you have your insurance through…

[ ] CommChoice

[ ] CommCare

[ ] Commonwealth Care Bridge

[ ] No (SKIP TO Q18)

[ ] DON’T KNOW

16. Have you changed or gotten new health insurance since 2006?

[ ] YES  Please tell me how you got it.

(PROBE FOR WHO PROVIDED IT AND HOW THEY APPLIED)

______________________________________________________________

[ ] NO

17. The Health Connector is a state agency that helps Massachusetts residents find health care coverage. Have you ever had health insurance through the Health Connector?

[ ] YES

[ ] NO

[ ] UNSURE/DON’T KNOW

18. How many children under the age of 18 live in your household? __________

19. Counting you, how many adults live in your household? ___________

20. This next question is about income. We know that people aren’t used to talking about their income but we ask this question so that we can represent different groups of people in the focus group. This includes people of different income levels. Is [your/the combined] total annual income [of everyone living in this household] above or below $[XXX – FILL WITH FPL rounded to nearest $1000 FOR # PEOPLE IN HH (WEIGHTED)]?

[ ] ABOVE

[ ] BELOW (SKIP TO Q21)

20b. Is [your/the combined] total annual income [of everyone living in this household] above or below $[xx – FILL WITH 300% of FPL rounded to nearest $1000 FOR # PEOPLE IN HH (WEIGHTED)]?

[ ] ABOVE

[ ] BELOW

21. Have you ever been to a focus group before?

[ ] Yes

[ ] No (SKIP TO Q22)

21a. In the last 12 months, how many have you been to?

[ ] None (SKIP TO Q22)

[ ] One

[ ] Two

[ ] Three

[ ] Four or more (SKIP TO Q22)

21b. When was the most recent time?

21c. What was it about?

22. How did you hear about this study?

23. Thank you so much for your interest. If you qualify, we contact you with the details for the focus group date and location.

ADDRESS:

Best Contact Number___________________

Alternative Number____________________