What You Can Do for School Wellness Communication Tools Testing

Attachment C

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

Focus Group Screening Questionnaire – Middle School Teachers

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

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

SPECS:

• One, 120-minute group with middle school (grades 6-8) teachers per location:

• Recruit 14 for 8 to show (seat) at each group.

• We will NOT recruit teachers who specialize in health or PE exclusively (see Q5).

• All teachers must be employed by a middle school that offers the National School Lunch Program (we will provide facility with a list of eligible local schools for recruitment).

• All teachers must not work at a middle school that has won a HUSSC (HealthierUS School Challenge) award (we will provide facility with a list of local schools not eligible for recruitment).

• 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: middle school teachers (Room TBD)	TBD	TBD	Atlanta, GA
[ ]	Group 2: middle school teachers (Room TBD)	TBD	TBD	Des Moines, IA
[ ]	Group 3: middle school teachers (Room TBD)	TBD	TBD	Dallas, TX

Hello, my name is _____with______. We are conducting a study about nutrition on behalf of the federal government, 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 teachers in your area to participate in a focus group to help us understand more about what they think about nutrition and health. This should only take a few minutes. READ OMB STATEMENT (see top of screener).

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

Female……	[ ]	Continue
Male ……..	[ ]	Continue, Recruit at least 2

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 currently teach at a middle school?

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

4. How long have you taught middle school?

Less than 5 years	[ ]
5-10 years	[ ]	Recruit at least 2 in each category
10-20 years	[ ]
More than 20 years	[ ]

5. What grade(s) do you teach and what is the name of your school?

Grade(s)	Name of School

*RECRUIT MIX OF GRADES

*RECRUIT NO MORE THAN TWO TEACHERS FROM THE SAME SCHOOL

6. What subject(s) do you currently teach? [Read list and accept multiple answers]

Health	[ ]	Terminate
Physical Education/PE	[ ]	Terminate
Work/Family Studies	[ ]	Terminate
Cooking/Home economics	[ ]	Terminate
Other _________________	[ ]	Recruit a Mix & Continue

7. Does 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…………….	[ ]

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

Yes……..………………	[ ]	Continue
No………………………	[ ]	Skip to Q10

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

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

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

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

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

Under 21…………	[ ]	Terminate
21-34 …….……...	[ ]	Record
35-50…….………	[ ]
50+ ……...............	[ ]

12. Are you of Hispanic or Latino origin?

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

13. 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 6*

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

14. Take a moment and think about your students’ health. What is the biggest concern you have about your students’ 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: _________________________________________________