Evaluation of health communication messages for
Infertility Prevention Campaign
Attachment 3B
Mall Intercept Screener & Moderator Guide: Female Adult & Minor (15-25 yr old)
Form approved
OMB no. 0920-XXXX
Expiration date xx/xx/20xx
Mall Intercept Screener & Interview Guide (15-25)
Project: Chlamydia Screening materials [posters]
Client: CDC
Reading level: 7
Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions and completing survey. 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)
Recruit at least 100 girls ages 15–17 and 100 young women ages 18–25.
Invitation
Hello, I’m _______________ with _____________________, an independent consumer research firm. We are conducting a research study with young women ages 15 to 25 on behalf of the U.S. Centers for Disease Control and Prevention (CDC). We are giving away $5 gift certificates to _________ or ________ today to young women who will answer a few questions for us about a [poster/other product]. The questions will take about 5 to 10 minutes of your time. The poster is a public health message about avoiding complications from sexually transmitted diseases.
Your participation is entirely voluntary and there will be no physical risk to you. You do not have to answer questions that you don’t want to, and you may stop at any time.
Before taking the survey, you will need to answer a few questions to see if you qualify. If you qualify, you will be taken directly to the survey to answer questions about a poster. When you are finished the survey, you will get a $5 certificate. If you do not qualify, you will find out right away, and you will not receive the $5 gift certificate. Would you be willing to answer a few questions to see if you qualify to participate and receive the gift certificate?
Some of these questions may sound personal but this information will help me to ensure that we speak with a variety of people. I won’t see your responses, and we won’t need your name or any other information that could identify you in any way.
If you have questions about your rights as a research participant, you can call CDC directly at 1-800-584-8814. If you have specific questions or concerns about this research study, you can call Dr. Elyse Levine at (202) 884-8913. I will give you these contact numbers again at the end of the survey.
The following questions will be answered by the participant on a PDA or laptop programmed to accept/terminate as indicated.
What is your age? _____ Record age
( ) Under 15 …………………………………………………………………..Terminate
( ) 15–17 Continue
( ) 18–25 Continue
( ) 26 or older Terminate
Recruit a mix between 15 and 25.
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 Terminate
( ) No Continue
Have you ever, or do you currently work or volunteer in the field of sexual or reproductive
health?
( ) Yes Terminate
( ) No Continue
Do you feel comfortable responding to materials that require a 7th grade reading level?
( ) Yes Continue
( ) No Terminate
|
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? |
|
|
[Program will terminate only if “no” to all]
Are you Hispanic/Latina?
( ) Yes Continue
( ) No Continue
( ) Don’t Know Terminate
Program recruits according to sample needs and site.
Are you . . . ?
( ) African American/Black Continue
( ) Caucasian/White Continue
( ) Asian Terminate
( ) Native American Terminate
( ) Refused to answer Terminate
Program recruits according to sample needs and site.
Are you currently enrolled in high school, college, or trade school?
( ) Yes Continue
( ) No Continue
Program recruits a mix.
Do you currently live with your parents or guardians?
( ) Yes Continue
( ) No Continue
Program recruits a mix.
When was the last time you visited a medical provider? By “medical provider” we mean someone like a doctor or nurse—not a 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
Program recruits a mix.
Invitation
Terrific! You qualify to participate and receive the $5 gift certificate. The purpose of this activity is to help CDC understand how to communicate with young women about measures they can take now to protect their health and prevent infertility in the future. As I mentioned earlier, I am going to be showing you a poster and then asking for your feedback about it. I was not involved in the creation of this poster, so whatever you say—positive or negative—is helpful to me. This poster is designed for young women between the ages of 15 and 25.
Show Poster. Respondent continues entering responses on PDA/laptop.
Please take a moment to look this over. [Wait for person to read entire poster, then continue]
Imagine this was a poster on a wall somewhere—maybe in a drug store, at a clinic or in a doctor’s office. How well does this poster catch your attention?
[Screen shows “Not at all/Very much” scale]
The Number 1 represents “not at all” and 5 represents “very much.”
1 2 3 4 5
How likely would you be to stop and read this poster?
[Screen shows “Likelihood” scale]
The Number 1 represents “not at all likely” and 5 represents “very likely.”
1 2 3 4 5
How much of the poster would you read?
[Screen shows the responses below]
( ) I would only read the headline
( ) I would only look at the image/s
( ) I would only read the headline and look at the image/s
( ) I would read the whole thing
( ) I wouldn’t read any of it
How easy is it to understand what the poster is saying?
[Screen shows “Not at all/Very easy” scale]
The Number 1 represents “not at all” and 5 represents “very easy”
1 2 3 4 5
How do you like the look of the poster?
[Screen shows “Not at all/Very much” scale]
The Number 1 represents “not at all” and 5 represents “very much”
1 2 3 4 5
Do the people shown on the poster seem like you or people you know or would like to know?
[Screen shows “Not at all/Very much” scale]
The Number 1 represents “not at all” and 5 represents “very much”
1 2 3 4 5
How old does the person/people on the poster look? Enter age or range ______________
After reading this poster, how likely are you to talk to a health care provider about screening for Chlamydia?
[Screen shows “Not at all/Very much” scale]
The Number 1 represents “not at all” and 5 represents “very much”
1 2 3 4 5
(If a score of 3 or less is entered) Please indicate why you would not be likely to talk to a health care provider about screening (check all the reasons that apply).
( ) I don’t think it’s important
( ) I don’t have time
( ) I don’t have a way to pay for it
( ) I’m afraid [of/to INSERT action]
( ) I don’t have a health care provider
( ) I would be embarrassed
( ) I don’t trust [INSERT item]
( ) I don’t want anyone to suspect I’m [INSERT action]
( ) I wouldn’t know where to go [INSERT action]
( ) I don’t know how to [INSERT action]
( ) I don’t want my partner to find out
( ) I’m not at risk for STDs (if this response is selected, provide “because” options)
( ) Because I’m in a monogamous relationship
( ) Because I’m not currently sexually active
( ) Because I use protection
( ) Because I’m careful about my partners
( ) Other: ____________________
Is there anything you would change to make it more effective for young women your age? [Responses recorded by interviewer]
Thank you very much for your time. Your feedback has been really helpful. [Give incentive]
If you have questions about this research, or if you think you have been harmed, you should talk to a parent, guardian, or doctor. You can also call CDC directly at 1-800-584-8814 with any questions about your rights as a participant. Leave a message with your name and phone number, and someone will call you back as soon as possible. If you have any other questions about the research, or if you think you have been harmed in any way by participating, please call Dr. Elyse Levine at (202) 884-8913.
Mall
Intercept Screener and Moderator Guide
| File Type | application/msword |
| File Title | Infertility Prevention Campaign Formative Research Protocol Memorandum |
| Author | AED_USER |
| Last Modified By | vbs6 |
| File Modified | 2009-07-15 |
| File Created | 2009-06-19 |