Screener for English Speaking

Page 5 of 5

Concept Testing for HRSA Poison Control Center Awareness

Screener for English Speaking Groups

Recruiting Goals:

• Each group should be comprised of 9 adults over the age of 18.

• Participants should either:

  • Be the parent of a child age 5 or under (recruit 4/5 per group); or

  • Be a caregiver to a family member (recruit 4/5 per group).

• Members of the same family cannot participate in the same group.

• All female.

• Mix of racial and ethnic backgrounds.

• Household income less than $75,000.

• Does not work in the field of market or opinion research, media, advertising or public relations, medicine or pharmacy, or for the federal government.

• Participants shall not have participated in a focus group or other qualitative research study in the past 12 months.

Introduction:

Hello, my name is ___________________________. This is not a sales call. I am working with a research firm that will be holding focus groups in the near future and would like to include your views, if selected.

May I ask you a few short questions to see if you would qualify for our study?

• No (TERMINATE)

• Yes (CONTINUE)

Note whether respondent is male or female.

• Male (TERMINATE)

• Female (CONTINUE)

Your answers to these questions are strictly confidential. We will never release your identity or answers to these questions to anyone other than the organization that is conducting the research, TMNcorp. TMN needs to know how you answered these questions so that they can determine whether you qualify for the discussion groups. You are not required to answer any of these questions, and if you wish to end this interview at any time, you may.

Screening Questions:

Q1. Do you, or does anyone in your household, work for:

[READ EACH AND WAIT FOR “YES” OR “NO” FOR EACH]

• A market research firm (TERMINATE)

• The media (TERMINATE)

• An advertising or public relations agency (TERMINATE)

• A medical or pharmaceutical office or firm (TERMINATE)

• A federal or state government agency (TERMINATE)

2. We are looking for people from diverse backgrounds. In which of the following racial and ethnic groups do you place yourself? [NOTE ALL THAT APPLY]

• Caucasian (CONTINUE)

• Black or African American (CONTINUE)

• Hispanic or Latino (CONTINUE)

• Asian, Asian Indian, Pacific Islander, or Native Hawaiian (CONTINUE)

• Other: ___________ (CONTINUE)

• Don’t know [DNR] (TERMINATE)

• Refused [DNR] (TERMINATE)

[CAUCASIAN- NO MORE THAN 4]

GOAL: 3 – CAUCASIAN, 2 – BLACK, 2 – HISPANIC, 2 – ASIAN

Q3. Which of the following groups includes your age? (READ LIST)

• Under 18 [Ask to speak to someone over age 18. If no one is available, TERMINATE]

• Between 18-30 years (CONTINUE)

• Between 31-45 years (CONTINUE)

• Between 46-50 years (CONTINUE)

• Between 51-64 years (CONTINUE)

• 65 and over (CONTINUE)

4. Do you have any children?

• Yes (CONTINUE)

• No (GO TO Q6)

4. Are your children 5 or under?

• Yes (GO TO Q7)

• No (CONTINUE)

4. Are you a caregiver for a family member?

• Yes (CONTINUE)

• No (TERMINATE)

[RECRUIT NO MORE THAN 4/5 PER GROUP]

4. Please stop me when I mention your yearly household income: (READ LIST)

• Less than $25,000 (CONTINUE)

• Between $25,000 and $50,000 (CONTINUE)

• Between $50,000 and $75,000 (CONTINUE)

• Between $75,000 and $100,000 (TERMINATE)

• More than $100,000 (TERMINATE)

• Don’t know/Refused (TERMINATE)

4. We would like to invite you to participate in a group discussion to review some information about health and safety. The focus group will last about 90 minutes. It will be audio taped and a staff member will be observing and taking notes. You will be paid $75 for your participation. Would you be willing to participate in this focus group?

• Yes (CONTINUE)

• No (TERMINATE)

The discussion will take place at ________________________________________

on ____________at _____a.m./p.m. We are inviting only a few people, so it is very important that you notify us as soon as possible if you are unable to attend. Please call (insert name of recruiter) at (insert telephone number) if this should happen.

Termination Script: I'm sorry, but we are currently looking for people who fit a different profile. Thank you for your time and interest in this research.

OMB Control Number: 0915-0212 Exp date 7/31/2015 HRSA Poison Help Campaign