Focus Group Screener for Minors

Evaluation of health communication messages for

Infertility Prevention Campaign

Attachment 3D

Recruitment Screener for Minors

2/2/2021

Form approved

OMB no. 0920-XXXX

Expiration date xx/xx/20xx

Focus Group Screener for Minors

Infertility Prevention Campaign

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time to respond to these 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX)

I would like to ask you a few questions to see if you qualify to participate in a 2 hour discussion group (or focus group) the CDC is conducting to understand how to communicate with teens and young women about measures they can take now to protect their health and prevent infertility in the future. The focus groups will ask teens to give their opinions on how information is presented and whether it is easy to understand. Everyone who participates in these discussions will be paid $75. My questions today will only take a few moments to answer, and if you are selected, I will schedule you for a focus group at a time that is convenient for you. Do you have time now to answer a few questions?

I’m going to ask you several health-related questions. Some of these questions may sound personal but this information will help me to ensure that the groups will include a lot of different people.

Note for Recruiters:

Please use the following language for termination of screening:

“I’d like to thank you very much for your time today. We are looking to recruit a mix of young women from across the country to help with this study. Right now we are still in the process of recruitment, and if we need your help, we will call you back.”

1. What is your age? ____ Record Age

( ) under 15 Thank and terminate

( ) 15–17 Continue

( ) over 17 Thank and terminate

2. Have you participated in a market research study in the past 6 months, in which you were paid to provide your opinions regarding a product, a service, or advertising on the topic of STDs or sexual/reproductive health?

( ) Yes Thank and terminate

( ) No Continue

3. Have you ever, or do you currently work or volunteer in the field of sexual or reproductive

health?

( ) Yes Terminate

( ) No Continue

4. Do you feel comfortable responding to materials that require a 7^th grade reading level?

( ) Yes Continue

( ) No Terminate

Question	Yes	No
1. Have you ever had a pelvic exam or Pap test?
2. Have you ever asked to be tested for a sexually transmitted disease (STD)?
3. Have you ever had sexual intercourse?

Thank and terminate only if “no” to all.

[*ONLY if asked for a definition: “Sexual intercourse” refers to sexual activity when a penis is put inside a vagina.]

6. Are you Hispanic/Latina?

( ) Yes Continue

( ) No Continue

( ) Don’t Know Terminate

7. Are you . . . ?

( ) African American/Black Continue

( ) Caucasian/White Continue

( ) Asian Ask #8, then Thank and terminate

( ) Native American Ask #8, then Thank and terminate

( ) Refused to answer Terminate

Recruit one-third each of Hispanic, African American, and Caucasian.

8. Tell me a little bit about a good movie or TV show that you’ve seen recently—what was the movie or TV show, and what did you like about it?

[Note: This question is intended to establish whether the respondent is reasonably articulate, fluent in English, and willing to converse. If respondent has a strong accent, difficulty speaking English, serious speech impediment or has trouble communicating (e.g., “shuts down”), thank and terminate.]

9. [During summer months] This fall, will you be attending high school or home school?

[During school year] Do you currently attend high school or home school?

[Note, GED program counts as “no”]

( ) Yes Continue

( ) No Continue

Recruit “Yes” for Group A.

Recruit “No” for Group B.

10. When was the last time you visited a doctor or nurse for a health checkup (this does not include visits to the dentist, optometrist, or psychologist).

( ) Within last six months Continue

( ) Within last year Continue

( ) Between one and two years ago Continue

( ) More than two years ago Continue

Recruit a mix.

11. What type of healthcare provider did you see?

( ) General practitioner/Internist Continue

( ) OB/GYN Continue

( ) Medical specialist other than GYN Continue

( ) Nurse practitioner Continue

( ) Nurse Continue

( ) Other [Record]: ____________________ Continue

12. Now I am going to read you a short description of the project, and I will need to confirm that you want to participate. After I do that, I will schedule you for a focus group.

[Read and complete “Minor Assent Form”]

5

Focus Group Screeners