1 Recruitment Screener Fathers

OMB Number: 0925-0643

Expiration Date: 10/31/2014

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

National Child and Maternal Health Education Program (NCMHEP)

Understanding Perceptions of

Postpartum Depression

To Inform Educational Outreach Efforts

--Focus groups with fathers with at least 1 child less than 5 years of age--

RECRUITMENT SCREENER:

1 60-MINUTE TELEPHONE FOCUS GROUP

Background

We are conducting a telephone focus group with fathers to talk about parents’ and children’s health shortly after birth. We are not selling or promoting any product or service. Everyone who participates in the focus group will receive $20 as a token of appreciation for your time. The telephone focus group will last 60 minutes. The discussion will be audio-recorded and kept secure to the extent permitted by law. First names only will be used during the discussion. In the final summary report, your individual name will never be connected to a comment you make during the discussion. To see if you qualify to participate in the focus group discussion, we need to ask you a few questions. These questions will take less than 5 minutes.

Eligibility Questions

RECRUIT 12 TOTAL PARTICIPANTS FOR EACH FOCUS GROUP (9 PARTICIPANTS WILL BE SEATED; ALL PARTICIPANTS WHO SHOW, EVEN THOSE WHO ARE EXCUSED, WILL RECEIVE THE INCENTIVE).

Confirm that the individual speaks English clearly. _____

1. Are you a father of at least 1 child less than 5 years of age?

( ) Yes

( ) No THANK AND TERMINATE

2. Do you currently live with both the child and the mother who gave birth to the child?

( ) Yes

( ) No THANK AND TERMINATE

[Note to the recruiter: “The child” in question #2 must refer to the child in question #1.]

3. Has your wife/girlfriend/significant other (and the mother of the child and who gave birth to the child) ever been diagnosed with postpartum depression by a health care professional?

( ) Yes [2 PARTICIPANTS IN THE MALE FOCUS GROUP MUST HAVE A WIFE/PARTNER WITH PPD.]

( ) No [2 PARTICIPANTS IN THE MALE FOCUS GROUP MUST HAVE A WIFE/PARTNER WITH PPD.]

[If necessary, read definition: Postpartum depression is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 3 months after delivery.]

4. What is your age? _____ years

5. What is your city and state? ________________

RECRUIT A MIX OF GEOGRAPHIC LOCATIONS.

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

( ) Some high school

( ) Completed high school

( ) Some college/university

( ) Some technical school

( ) Completed college/university/technical school

( ) Any advanced degree

If yes to advanced degree, ask which field the respondent earned the degree in.

[SCREEN OUT PHYSICIANS (MEDICAL DOCTORS), NURSE PRACTITIONERS (NPs), NURSES, AND MENTAL HEALTH PROFESSIONALS]

7. Which of the following categories best describes your ethnic background?      

(     ) Not Hispanic or Latino

(     ) Hispanic or Latino

8. Which of the following categories best describes your racial background?

(     ) White.............................................................................................................Continue

(     ) Black or African American...........................................................................Continue

(    ) American Indian or Alaska Native................................................................Continue

(     ) Asian………….............................................................................................Continue

(     ) Native Hawaiian or Other Pacific Islander ………………………………..Continue

9. What was your total household income before taxes during the past 12 months?

(     ) Less than $25,000

(     ) $25,000 to $34,999

(     ) $35,000 to $49,999

(     ) $50,000 to $74,999

(     ) $75,000 to $99,999

(     ) $100,000 to $149,999

(     ) $150,000 or more

10. How well do you agree with this statement?

“My significant other can really talk to me about her feelings.”      

(     ) Strongly agree

(     ) Agree

(     ) Slightly agree

(     ) Slightly disagree

(     ) Disagree

(     ) Strongly Disagree

[Use the following language when terminating a call:
“Thank you very much for your time today. We are looking to recruit a wide variety of men from across the United States to help with this study. Unfortunately, we have filled participant slots with your specific characteristics. Again, thank you for your interest.”]

INVITATION

Thank you for answering our questions. We would like to invite you to participate in a 1-hour telephone focus group discussion with other men to hear your thoughts on parents’ and children’s health shortly after birth. If you agree to participate you will receive $20as a token of appreciation for your time.

• Are you interested and able to participate?

( ) Yes SCHEDULE

( ) No THANK AND TERMINATE

FOR SCHEDULED PARTICIPANTS:

We will send you a confirmation email, with the call-in instructions, before your telephone focus group discussion. And, we will call you the day before the focus group discussion as a reminder. Please call into the call-in number at least 5 minutes before the start of your focus group.

Name_________________________________________________________________

Address_______________________________________________________________

City/State/Zip Code_______________________________________________________

Home___________________ Work _______________ Cell ____________________

Email ­­­­­­­­­­­­­­­___________________________________________________________

What is the best telephone number to reach you? ________________________

Thank you!

Public reporting burden for this collection of information is estimated to average 5 minutes, 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 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0532). Do not return the completed form to this address.