What You Can Do for School Wellness Communication Tools Testing

Attachment B

OMB Control # 0584-0524

Expiration Date: 04/30/2013

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0584-0524.  The time to complete this information collection is estimated as part of the 10 minutes for the screener, including the time for reviewing instructions and completing the information.

USDA/FNS

Mini Group Screening Questionnaire – Parents

Evaluative Round (July 2011): Atlanta, GA; Des Moines, IA; Dallas, TX

RESEARCH CONTACT: Erica Sandler at 202-973-2949 or [email protected]

SPECS:

• Two, 120-minute mini groups with parents of middle school (grades 6-8) students per location:

  • 1 group with mothers

  • 1 group with fathers

• Recruit 12 for 6 to show (seat) at each group.

• All parents must be actively involved in their child’s education and extracurricular activities (see Q12).

• 2 of the 6 of the parents in each group must be in a low income household (see Q15,16).

• All parents must have a child that attends a middle school that offers the National School Lunch Program (we will provide facility with a list of eligible local schools for recruitment).

• All parents may not have a child that attends a middle school that has won a HUSSC (HealthierUS School Challenge) award (we will provide facility with a list of schools not eligible for recruitment).

• There will be a focus group for middle school students on the same date/location. These parents WILL NOT be parents of the children selected for those sessions.

• All respondents must speak English.

• All respondents must be outgoing, responsive, articulate, willing and able to read and react to written materials, and must be willing to speak openly in a group.

EVALUATIVE: PLEASE RECRUIT RESPONDENTS AS FOLLOWS:

	GROUP	DATE*	TIME	LOCATION
[ ]	Group 1: fathers of middle school aged children (Room TBD)	TBD	TBD	Atlanta, GA
[ ]	Group 2: mothers of middle school aged children (Room TBD)	TBD	TBD	Atlanta, GA
[ ]	Group 3: mothers of middle school aged children (Room TBD)	TBD	TBD	Des Moines, IA
[ ]	Group 4: fathers of middle school aged children (Room TBD)	TBD	TBD	Des Moines, IA
[ ]	Group 5: fathers of middle school aged children (Room TBD)	TBD	TBD	Dallas, TX
[ ]	Group 6: mothers of middle school aged children (Room TBD)	TBD	TBD	Dallas, TX

Hello, my name is _____with______. We are conducting a study about nutrition on behalf of the United States Department of Agriculture, Food and Nutrition Service, and I would like to ask you a few questions. I’m not trying to sell you anything. We would like to invite a number of parents in your area to participate in a focus group to help us understand more about what they think about nutrition and health. May I speak to the female/male head of household? This should only take a few minutes. ONCE HEAD OF HOUSEHOLD ON PHONE, REPEAT INTRODUCTION AND READ OMB STATEMENT (see top of screener).

1. Record Gender—DO NOT ASK UNLESS UNABLE TO TELL.

				Formative	Evaluative
Female……	[ ]	Continue		Groups 1,4,5	Groups 2,3,6
Male ……..	[ ]	Continue		Groups 2,3,6	Groups 1,4,5

2. Do you, or does anyone in your household, work for a radio station, television station, newspaper, market research company, advertising or public relations company?

Yes……	[ ]	Terminate
No……..	[ ]	Continue

3. Do you have any children under age 19 living at home?

Yes…………	[ ]	Continue
No …….…..	[ ]	Terminate

4. How old are your children? [check all that apply]

Under 4…………	[ ]
4-7 years old.…..	[ ]
8-10 years old.….	[ ]
11-13 years old…	[ ]	If this is checked, continue. If not, terminate.
14 and up……….	[ ]

5. [If child is between the ages of 11-13, ASK] Is your child in middle school?

Yes……………….	[ ]	Continue
No.………………	[ ]	Terminate

6. What grade is your child in?

____________ [Record answer]

7. What is the name of the middle school your child attends?

____________ [Record answer]

*Recruit no more than 2 parents who have children enrolled at the same middle school.

8. Are you or your child a vegetarian?

Yes……………….	[ ]	Terminate
No.………………	[ ]	Continue

9. Does your child have a food allergy or medical condition that requires a specialized diet?

Yes……………….	[ ]	Terminate
No.………………	[ ]	Continue

10. Do you or anyone in your household work in any of the following industries? [Record each “yes” response.]

	Yes
Healthcare/Medical………………………………	[ ]	Terminate if “YES” to any
Nutrition/Food Service……..……………………	[ ]
Fitness……..……………………………………..	[ ]
Food manufacturing……………………………..	[ ]
School Food Service…………….…………….…	[ ]
Food/Nutrition Assistance Programs…………….	[ ]

11. Have you ever participated in a focus group or been paid to be part of a discussion group?

Yes……..………………	[ ]	Continue
No………………………	[ ]	Skip to Q11

12. How recently did you participate in a focus group?
    
    

Less than 6 months ago	[ ]	Terminate
6 months ago or longer	[ ]	Continue

13. Generally speaking, do you consider yourself to be an “expert” in nutrition?

No………………….	[ ]	Continue
Yes …….…….……	[ ]	Terminate
Don’t know/Refused...	[ ]	Terminate

14. Are you currently involved in or volunteer in any of the following activities?

	Yes	No
Parent/Teacher Organization or Association (often called PTA, PTO or PTSA)	[ ]	[ ]	Continue if “YES” to any
Your child’s academic clubs such as math, science, chess, foreign language, etc..………………………….	[ ]	[ ]
Your child’s church or religious youth group…………	[ ]	[ ]
Your child’s extracurricular activities such as sports, dance, scouts, etc.……..………………………………	[ ]	[ ]
Volunteering for field trips or other school activities…	[ ]	[ ]

15. Including yourself, how many people currently live in your household?

__________ [Record answer]

1. What is your total annual household income? [Do not read list]

Less than $19,000…………	1	Record number below
$19,000 - $25,000…………	2	Record number below
$25,001 - $32,000…………	3	Record number below
$32,001 - $38,000…………	4	Record number below
$38,001 - $45,000…………	5	Record number below
$45,001 - $51,000…………	6	Record number below
$51,001 - $58,000…………	7	Record number below
$58,001 - $64,000…………	8	Record number below
More than $64,000………..	[ ]	Recruit no more than 2
Don’t know/Refused ……...	[ ]	Terminate

Answer to question 15: ____________ Answer to question 16: _______________

Accept respondent if he/she falls into one of the following categories:

___ Has 2 people in household (Q15), and answer to Q16 is 1 or 2.

___ Has 3 people in household (Q15), and answer to Q16 is 1, 2, or 3

___ Has 4 people in household (Q15), and answer to Q16 is 1, 2, 3, or 4

___ Has 5 people in household (Q15), and answer to Q16 is 1, 2, 3, 4, or 5.

___ Has 6 people in household (Q15), and answer to Q16 is 1, 2, 3, 4, 5, or 6.

___ Has 7 people in household (Q15), and answer to Q16 is 1, 2, 3, 4, 5, 6, or 7.

___ Has 8+ people in household (Q15), and answer to Q16 is 1, 2, 3, 4, 5, 6, 7, or 8.

[INTERVIEWER, RECORD WHICH CATEGORY RESPONDENT FALLS INTO]

17. What is your current age? [Do not read list]

Under 18…………	[ ]	Terminate
18-34 …….……...	[ ]	Record
35-50…….………	[ ]
50+ ……...............	[ ]	Terminate

18. Are you of Hispanic or Latino origin?

No………………….	[   ]	Continue
Yes …….…….……	[   ]	Continue

19. What is your race?   (READ LIST. ACCEPT MULTIPLE ANSWERS.)

American Indian or Alaska Native………...	[   ]
Asian ….…….…………………………….	[   ]
Black or African American …….………	[   ]
Native Hawaiian or Other Pacific Islander..	[   ]
White………………………………………	[   ]	Recruit no more than 3*

*TO THE EXTENT POSSIBLE, THE GROUPS SHOULD BE A MIX OF RACES/ETHNICITIES.

20. What is the highest level of education you have completed? [Do not read list]

High school graduate or less.…….……...	[ ]	Recruit a mix
Some college, vocational or technical school………………………………........	[ ]
College graduate………………………...	[ ]	Recruit no more than 4
Post graduate education (e.g., Master’s degree, MBA, law degree, PhD)………...	[ ]	Recruit no more than 2

21. Are you currently employed?

Yes, full-time……………...	[ ]	Recruit a mix
Yes, part-time………………	[ ]
No…………………………	[ ]

22. Are you ……….

Married………………………...	[ ]	Recruit a mix
Single, never married …………	[ ]
Separated/divorced/widowed…	[ ]

23. Take a moment and think about your child’s health. What is the biggest concern you have about your child’s health and why?

Recruiter: After recording respondent’s answer, determine whether or not you feel this respondent would be useful in the group. Did they:

• Give full and complete answers?

• Speak clearly, and without long pauses?

• Answer enthusiastically?

• Speaks understandable English/is comfortable with the language

It is most important that respondent be articulate!! If not, terminate.

I would like to invite you to participate in a group discussion that will be held at our facility on (DATE) at (TIME). The group will last approximately 120 minutes. To help with inconveniences such as child care you will receive $100 at the end of the group session. Would you be willing to participate?

Yes……………( ) SCHEDULE No……………..( ) TERMINATE

I will call you to remind you of this appointment. However, if for some reason you are unable to attend, please call me at (TELEPHONE NUMBER) so that I can find a replacement for you. Thank You.

Respondent’s name: ___________________________________________

Address: ____________________________________________________

Telephone # (Home): __________________ (Work) _________________

Recruited by: _________________________________________________