Form for Generic Fast Track Clearance_Focus Groups FINAL

Request for Approval under the “Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NINR)” (OMB Control Number: 0925-0653)

TITLE OF INFORMATION COLLECTION: Focus Groups on proposed materials for a pediatric palliative care communications campaign

PURPOSE:

This is a request for OMB to approve focus groups that will be conducted on behalf of the National Institute of Nursing Research (NINR), part of the National Institutes of Health (NIH), to inform their new pediatric palliative care communications campaign. The purpose of the campaign is to increase the use of palliative care for children living with serious illness or life-limiting conditions. This method will help gather feedback on campaign branding and materials.

The proposed focus groups will collect information on the attitudes, preferences, and experiences of NINR stakeholders relating to future communication materials for this campaign. The target audience for this project includes health care providers that treat or consult with pediatric patients living with a serious illness or life-limiting condition and their families.

DESCRIPTION OF RESPONDENTS:

The data collection process will include conducting a total of two online focus groups among health care providers. The primary audiences for the focus groups will include:

• Physicians working in a hospital

  • Both men and women;

  • Those who currently work with pediatric patients living with a serious illness of life-limiting condition and their families

• Nurses working in a hospital

  • Both men and women;

  • Those who currently work with pediatric patients living with a serious illness of life-limiting condition and their families

• Social workers working in a hospital

  • Both men and women;

  • Those who currently work with pediatric patients living with a serious illness of life-limiting condition and their families

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[X] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: ______________Adrienne Burroughs, MHS, NINR/NIH__________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ X ] Yes [ ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [X ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [X ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [X] Yes [ ] No

In accordance with NIH and OMB guidance, NINR proposes a $40 honorarium be provided to each participating respondent as a token of appreciation for their time.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Private Sector, Physicians	8	90 minutes	12 hrs
Private Sector, Registered Nurses (includes nurse practitioners and clinical nurse specialists)	8	90 minutes	12 hrs
Private Sector, Social Workers	8	90 minutes	12 hrs
Private Sector, Recruitment	45	10 minutes	7.5 hrs
Totals	69		43.5 hrs

FEDERAL COST: The estimated annual cost to the Federal government is _$31,000

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe?

[ ] Yes [X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

A description of how the potential group of respondents will be identified and selected is included in the attached “Focus group screener and consent” document labeled Appendix A.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Appendices:

Appendix A: Focus group screener and consent

Appendix B: Screenshots - Focus group screener and consent

Appendix C: Focus group moderator guide

Appendix D: Screenshots - Focus group

Appendix E: Materials

• Interactive worksheet/ Tear-off pad

• Description of video vignettes

• Storyboards for video module 1

• Script for video module 1 (will be read when showing the storyboards)

• Storyboards for video module 2

• Script for video module 2 (will be read when showing the storyboards)

• Logo options

Appendix F: Correspondence

• Focus group invitation email

• Phone script invitation to participate in focus group screening (to be used if emails are

unavailable)

• Follow-up email for those who agreed to participate in the focus group screening

• Focus group reminder email with instructions

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