Focus Group Screening Instrument for Parents and Youth

Attachment M: Focus Group Screening Instrument for Youth and Script for Obtaining Parental Consent

Focus Group Screening Instrument

For Youth

And

Script for Obtaining

Parental Consent

Form Approved

OMB No. 0920-0816

Exp. Date 06/30/2012

Public reporting burden of this collection of information is estimated at 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency many 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, GA 30333; Attn: PRA (0920-0816).

Youth Screener

RESPONDENT CONTACT INFO (for research vendor use only)

Respondent’s Name: ______________________________________

Address: __________________________________________________

Phone Numbers:

Home: ___________________________________________

Cell: ___________________________________________

Parent Cell/Home: _____________________________________________

Boys and girls ages 11-14 and 15-18 will be recruited in person in community settings (e.g. community centers). If a tween or teen meets the recruiting criteria and expresses interest in participating, their parent will be contacted by phone so study details can be provided, and consent for youth to participate can be obtained.

ESTABLISH CONTACT WITH TWEEN/TEEN INTERESTED IN PARTICIPATING, THEN BEGIN HERE: Hello. My name is ________ from ________, a consumer research company located here in (LOCATION). We are currently involved in a study to understand what teens think about healthy and unhealthy dating relationships and how to communicate with them about making positive choices in relationships. As part of our research study, we are conducting small group discussions with people your age (11 to 14 or 15 to 18 depending on where this tween/teen falls).

IF THEY ASK FOR MORE INFORMATION: Our research study will focus on the issue of “relationships in the lives of youth.” Some sample questions might be:: what types of behaviors are ‘healthy’ or ‘ok’ in a dating relationship, what language do you use to describe dating, going out, who are good and bad role models for healthy and unhealthy relationships, what type of materials and messages that are available are helpful to you about making positive choices in relationship; where information should be distributed (e.g., Boys & Girls Clubs, specific social networking sites); and draft content and designs developed for campaign materials.

The discussion would take place on ________, at __________, and take about 90 minutes. All of your answers will be kept confidential, will never be directly attributed to you, and will only be used as part of a summary report that we will write based on the X number of youth we are talking to throughout the country about these topics. You will be paid X for being part of the discussion.

If you are interested in participating, I have a few more questions to ask you to make sure you qualify. Are you interested in participating?

IF NO: Thank you for your time.

IF YES: Proceed to question 1.

1. How old are you?

   1. 11-14

   2. 15-18

2. What best describes your race?

   1. American Indian or Alaska Native

   2. Asian American or Pacific Islander

   3. Black or African American

   4. Hispanic

   5. White

3. Would you say the neighborhood that you live in is urban or suburban?

Urban 

Suburban  THANK AND END

4) Which of the following statements do you agree with the most? (MUST PICK ONLY ONE)

Friends are the most important thing in my life.  CONTINUE

Friends are pretty important, but not the most important thing to me.  CONTINUE

Friends are not that important in my life.  THANK AND END

If respondent falls within the needed criteria, then continue.

If respondent does not fall within the needed criteria, thank them for their time and end.

FINAL SCRIPT: In order for you to participate, we will need to get the permission of your parent or guardian. Can you provide me with their cell or home phone number, so I can call them and get them to give their permission for you to participate? We will also send them a letter outlining the details of the study, and a form that they need to sign. To participate, you will need to bring that form back with their signature, when you attend the discussion group.

USE NEXT PAGE TO SECURE VERBAL PERMISSION FROM PARENT

PARENTAL CONSENT TELEPHONE SCRIPT

RESPONDENT CONTACT INFO (for researcher use only)

Respondent’s Name: ______________________________________

Address: __________________________________________________

Phone Numbers:

Respondent Home: ___________________________________________

Cell: ___________________________________________________________________

Parent Home/Cell: ______________________________________________________

Boys and girls ages 11-14 and 15-18 will be recruited in person in community settings (e.g. community centers). If a tween or teen meets the recruiting criteria and expresses interest in participating, their parent will be contacted by phone so study details can be provided, and consent for youth to participate can be obtained.

PARENT TELEPHONE SCRIPT AND CONSENT PROCESS

ESTABLISH CONTACT WITH ADULT WHO IS THE PARENT/GUARDIAN OF TWEEN/TEEN INTERESTED IN PARTICIPATING, THEN BEGIN HERE: Hello. My name is ________ from ________, a consumer research company located here in (LOCATION). We are currently involved in a study to understand what teens think about healthy and unhealthy dating relationships and how to communicate with them about making positive choices in relationships. We would like to ask your permission for your child to participate in these discussions, which will help us to better understand how best to communicate with youth on the topic of healthy relationships.

As part of our research study, we are conducting small group discussions with boys and girls ages 11-14 or 15-18 (select appropriate age range depending on where this parent’s child falls).

IF PARENT WANTS TO KNOW THE NATURE OF THE QUESTIONS YOU’D BE ASKING THE CHILD, SAY: Our research study will focus on the issue of “relationships in the lives of youth.” Some potential discussion areas are: what types of behaviors are ‘healthy’ or ‘ok’ in a dating relationship, what language they use to describe dating, going out, who are good and bad role models for healthy and unhealthy relationships, what type of materials and messages that are available are helpful to them about making positive choices in relationship; where information should be distributed (e.g., Boys & Girls Clubs, specific social networking sites); and draft content and designs developed for campaign materials.

Your child has expressed interest in participating in this type of discussion. The group discussion would take place on _______, and take 90 minutes. All of his/her answers will be kept confidential, will never be directly attributed to him/her, and will only be used as part of a summary report that we will write based on the X number of youth we are talking to throughout the country about these topics. S/he will be paid X for their participation. Do you give permission for him/her to take part in this discussion?

IF YES: We will send you a follow up letter confirming all of the study details, and include a permission form for you to sign, and have your child return when s/he participates in the discussion.

Thank you very much.

IF NO: Thank you for your time.

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