Form #2 Form #2 Screening Instrument for Focus Groups

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OMB No. 0935-0179
Exp. Date XX/XX/XXXX

ttachment C – Screening Instrument for Focus Groups

FINAL DRAFT 9.13.11

[To be used by RTI when potential participants call toll-free number for scheduling]

Hello, my name is _______________ and I’m from RTI. Thank you for your interest in this study to gather feedback from purchasers and developers of health IT about tools and materials available online at the AHRQ website.

If you are eligible and choose to participate in the interview, you will receive $150 as a token of our appreciation for taking time to participate in this important study and for any direct costs you may incur as a result of your participation. Your participation would involve a focus group and will last no more than 90 minutes.

To see if you are eligible for this study, I need to ask you some questions. It is your choice to answer these questions. Your answers will be kept private to the extent permitted by law. You can refuse to answer a question or stop at any time.

If you are not eligible and/or choose not to be part of the study, all responses you give me today will be destroyed and you will not be contacted again.

My questions will only take a few minutes, can I ask them now?

Yes…………………………………………………..	1	CONTINUE
No……………………………………………………….	2	THANK and END

Public reporting burden for this collection of information is estimated to average 5 minutes per response, the estimated time required to complete the 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: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

1. Would you describe your main role as a health IT professional to be:

Developer	1	CONTINUE
Purchaser	2
Other	3
Other……………………………………………………	3	HOLD and confirm with PD

NOTE: Definitions can be read to participant for clarification of role.

Developers are those working for health IT vendors or organizations that create health IT applications used by consumers. They may also include researchers, many of whom are also developing or evaluating health IT applications aimed at health care consumers.

Purchasers are those working for organizations involved in the selection of health IT applications for use by consumers, often in coordination with health care providers (e.g., hospitals, physician practices, and community health centers). They also include health plans, pharmaceutical companies, consulting firms, foundations, other nonprofit organizations, and government purchasers at the Federal, State, and local levels.

2. Are you involved in the design or selection of health IT applications or systems for consumers at your organization?

Yes	1	CONTINUE
No……………………………………………………….	2	THANK AND END
Don’t know……………………………………….	3	HOLD and confirm with PD

3. Do these applications or systems incorporate both patient interaction and patient-specific feedback?

Yes	1	CONTINUE
No……………………………………………………….	2	THANK and END
Don’t know……………………………………….	3	HOLD and confirm with PD

You qualify for the study; I’d just like to ask you a few last questions about your role at your organization.

3. What is your main role within your organization?

Record: ____________

4. What is your role in designing/ purchasing health IT tools in your organization?

Record: ____________

5. For how many years has consumer health IT been a part of your job?

Record: ____________

5. On a scale of 1-5, with 1 being completely unfamiliar and 5 being extremely familiar, how familiar would you describe yourself with:

NOTE: If needed, definitions can be read to participant for clarification of role.

a. Health literacy

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Record: ____________

b. Usability

Usability is the extent to which a product can be used by intended users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.

Record: ____________,

c. Human-computer interaction resources

Human-computer interaction resources are those tools and resources that are used to assist in the study, planning, and design of the interaction between people and interactive computing systems.

Record: ____________

Closing for Ineligible Participants:

Thank you for answering all of my questions. Unfortunately, you are not eligible to be in this study. There are many possible reasons why people are not eligible for the study. These reasons were decided earlier by the researchers. We value your interest in this research study. Thank you for being willing to help us.

Invitation for Eligible Participants:

Thank you for answering all of my questions. As I mentioned earlier, we are talking to developers and purchasers and we would like to include your opinions in our research study.

FOR FOCUS GROUP:

We would like to invite you to take part in a focus group discussion [online/in-person] that will last about 90 minutes. You will not be asked to buy anything. You will be contacted at a later date to remind you of the focus group. Any information that you provide to us will be kept confidential to the extent permitted by law. We're simply interested in your opinions. For participating in the focus group, you will receive $150 as a token of our appreciation.

We will be audio taping the focus group and some project staff from AHRQ may be [listening/observing]. As I said, if you choose to participate, whatever you say will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). We will never link your name with any comment you make in the interview or in any report that we write.

[For online] You will need to have Internet access to participate in the focus group and we will email you instructions.

Would you like to participate in a focus group?

Yes	1	SCHEDULE FOCUS GROUP
No	2	[THANK and END]

CONTACT INFORMATION:

Name:

Organization:

Role:

Phone:

Email:

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