Conduct Focus Groups to Test Messages and Materials

ATTACHMENT A3

Interviewer: _______________ Date: _______________ Letter sent: _______________ Reconfirmation Call: _______________

Consumers Group: ___________

CONSUMER SCREENER FOR DIABETES FOCUS GROUP SESSIONS

CALL FROM DATABASE OR AT RANDOM

ASK TO SPEAK TO MALE/FEMALE HEAD-OF-HOUSEHOLD

RECRUIT 5 PER GROUP

Hello, I’m __________ with __________________, an independent research firm. We are conducting a research study on behalf of the U.S. Department of Health and Human Services and we would like to include your views. My questions will only take a couple of minutes. We are not selling or promoting any product or service. All of your answers will remain confidential and the information will be used only for this study.

1. First, have you or any member of your household ever worked:

For market research company _____

For an advertising agency or public relations firm _____

For the media (TV/radio/newspapers/magazines) _____

As a healthcare professional (as a doctor, nurse, other healthcare professional) _____

For a health insurance provider _____

For a managed care organization or any healthcare provider _____

For a medical practice _____

[IF YES TO ANY >> TERMINATE]

DO NOT RECRUIT ANYONE EVER EMPLOYED IN THE MEDICAL FIELD, IN HEALTHCARE, HEALTH INSURANCE, MARKETING, OR ADVERTISING

2. Are you currently an employee of the federal government?

TERMINATE >> Yes _____

No _____

3. What is your occupation? [If retired, indicate and record former occupation]

If married, what is your spouse’s occupation?

________________________________________________________

________________________________________________________

[CHECK FOR SECURITY >> CANNOT BE MEDCIAL / HEALTHCARE / HEALTH INSURANCE / PR / OR MARKETING RELATED]

4. Please tell me your age.

[CATEGORIZE IN RANGE BELOW]

[NEED MIX BY AGE (25-70)]

TERMINATE >> 24 or younger _____

25-29 _____

30-39 _____

40-49 _____

50-59 _____

60-69 _____

TERMINATE >> 70 or older _____

5. Do you make the decisions (or help make the decisions) about your health care or health insurance coverage? That is, do you review any paperwork and make the decisions about your doctors, your medical care, or your health insurance and bills, or does someone else make those decisions?

Yes _____

GET REFERRAL OR TERMINATE >> No (decisions are made by someone else) _____

6. Within the past 12 months/ 1 year, have you received any medical care?

Yes _____

TERMINATE >> No _____

7. Have you been diagnosed with diabetes?

Yes _____

TERMINATE >> No _____

8. What type of diabetes do you have?

Type I _____

Type II _____

Other: Please specify_____

I Don’t Know_____

9. What is the highest level of education you have completed?

[NEED GOOD MIX]

MAX. 1 PER GROUP >> Less than high school graduate _____

High school graduate _____

Some college _____

College graduate _____

RECRUIT MAX. 1 PER GROUP >> Post graduate studies or degree _____

10. So that we can be sure that all backgrounds are represented in our study, please tell me your race or ethnic origin. Are you …..? [NEED GOOD MIX]

Caucasian/white _____

African-American/black _____

Hispanic _____

Asian _____

Native American _____

(Specify) ________________________________ Other _____

11. Which of the following categories best describes your total, annual household income?

[NEED GOOD MIX]

Under $25,000 _____

$25,000 - $34,999 _____

$35,000 - $49,999 _____

$50,000 - $74,999_____

$75,000 or greater _____

12. [Record Gender] [NEED GOOD MIX]

Male _____

Female _____

13. Have you ever attended a focus group discussion or a personal interview for research purposes? By that we mean an informal, round-table discussion or a personal in-depth interview, conducted by a professional moderator, in which you were asked your opinions regarding a product, a service, or advertising?

ATTEMPT MAX. ½ >> ASK A-C >> Yes _____

INVITE TO GROUP >> No _____

1. How many of these groups have you attended?

______________________________ [ATTEMPT MAX. 2-3 EVER]

2. What was/were the topics discussed?

______________________________[IF HEALTHCARE, TERMINATE]

3. How long ago was the last one of these groups you attended?

______________________________ [MUST BE AT LEAST 6 MONTHS AGO]

[INVITE TO APPROPRIATE GROUP]

Thank you for answering all of my questions. As I mentioned earlier, we are conducting a research study on behalf of the US Department of Health and Human Services and would like to hear your views. In order to hear them first-hand, we are conducting an informal, round-table discussion to be held on [DATE] at [TIME]. The discussion will last about 1.5 hours and will be both enjoyable and informative. No one will attempt to sell you anything and no one will call on you as a result of your participation. As a token of our appreciation for your help in our research effort, you will receive a $75 cash honorarium at the time of the session. This is an important research effort and we hope that you will be part of it. We can only invite a few people to take part. Can we schedule your attendance?

[If yes, read ….. ]

14. As part of the discussion you may be asked to read and evaluate some written materials regarding health issues and discuss some privacy issues related to health care. Are you comfortable doing this and sharing your opinions with the group?

Yes _____

TERMINATE >> No _____

[If yes, read…] If you need glasses for reading or for watching TV, please be sure to bring them with you to the group.

Also, please be sure to bring a picture ID as you may be asked to show it to be admitted into the group.

[RECORD GROUP]

Group:

ID # ________________________________________________________

NAME: _________________________________________________

ADDRESS: _________________________________________________

CITY: _________________________________________________

ZIP CODE: _________________________________________________

PHONE: (DAY) _____________________________________

(EVE) _____________________________________

(CELL) _____________________________________

(EMAIL) _____________________________________