OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information and signing parent consent forms and confidentiality agreements.
USDA/FNS
Mini Group Screening Questionnaire – Children of Low-Income Mothers
Evaluative Round (February 2011): Baltimore, MD; Raleigh, NC; Phoenix, AZ
RESEARCH CONTACT: Radha Rajan at 202-973-3617 or [email protected]
SPECIFIC DATES: TBD
SPECS:
Two, 60-minute mini focus groups with low-income children, ages 8-10, per location.
Recruit 10 for 6 to show at each group.
Each child must be in a low income household (see Q9 and Q10); at least half must participate/be from a family that participates in one or more nutrition programs, such as WIC, SNAP, etc. (Q13).
Each child must be able to speak English.
All respondents must be outgoing, responsive, articulate, willing and able to read and react to written materials, and must be willing to speak openly in a group.
FORMATIVE: PLEASE SCHEDULE/RECRUIT RESPONDENTS AS FOLLOWS:
|
GROUP |
DATE* |
TIME |
LOCATION |
[ ] |
Group 1: low-income children, ages 8-10 |
TBD |
TBD |
Birmingham, AL |
[ ] |
Group 2: low-income children, ages 8-10 |
TBD |
TBD |
Birmingham, AL |
[ ] |
Group 3: low-income children, ages 8-10 |
TBD |
TBD |
Dallas, TX |
[ ] |
Group 4: low-income children, ages 8-10 |
TBD |
TBD |
Dallas, TX |
[ ] |
Group 5: low-income children, ages 8-10 |
TBD |
TBD |
Chicago, IL |
[ ] |
Group 6: low-income children, ages 8-10 |
TBD |
TBD |
Chicago, IL |
EVALUATIVE: PLEASE SCHEDULE/RECRUIT RESPONDENTS AS FOLLOWS:
|
GROUP |
DATE* |
TIME |
LOCATION |
[ ] |
Group 1: low-income children, ages 8-10 |
TBD |
TBD |
Baltimore, MD |
[ ] |
Group 2: low-income children, ages 8-10 |
TBD |
TBD |
Baltimore, MD |
[ ] |
Group 3: low-income children, ages 8-10 |
TBD |
TBD |
Raleigh, NC |
[ ] |
Group 4: low-income children, ages 8-10 |
TBD |
TBD |
Raleigh, NC |
[ ] |
Group 5: low-income children, ages 8-10 |
TBD |
TBD |
Phoenix, AZ |
[ ] |
Group 6: low-income children, ages 8-10 |
TBD |
TBD |
Phoenix, AZ |
ASK TO SPEAK TO THE HEAD OF THE HOUSEHOLD.
INTRODUCTION: Hello, my name is __________ from __________. We are conducting a study about nutrition on behalf of the United States Department of Agriculture’s, Food and Nutrition Service, which is part of the federal government, and I’d like to ask you a few questions. I’m not trying to sell you anything. We would like to invite a number of children in your area ages 8-10 to participate in a focus group to help us understand more about what they think about nutrition and health.
May I speak to the male or female head of household? This should only take a few minutes. ONCE ADULT ON PHONE, REPEAT INTRODUCTION AND READ OMB STATEMENT (see top of screener).
Do you, or does anyone in your household, work for a radio station, television station, newspaper, market research company, advertising or public relations company?
Yes…… |
[ ] |
Terminate |
No…….. |
[ ] |
Continue |
Do you or does anyone in your household work in any of the following industries? [Record each “yes” response.]
|
Yes |
|
Healthcare…………………………… |
[ ] |
Terminate if “YES” to any |
Nutrition………………….. |
[ ] |
|
Fitness………………………….. |
[ ] |
Do you have any children between the ages of 8-10 living at home with you?
Yes…………………………… |
[ ] |
Continue |
No………………….. |
[ ] |
Terminate |
What is/are the age(s), grade(s) and gender(s) of the child/ren currently living at home with you, starting with the youngest? (RECORD INFORMATION IN COLUMNS OF TABLE BELOW)
TERMINATE IF NO CHILD BETWEEN THE AGES OF 8-10 YEARS OLD LIVING IN HOUSEHOLD.
|
Gender |
Age |
Grade |
Name of School |
1 (youngest) |
|
|
|
|
2 |
|
|
|
|
3 |
|
|
|
|
4 |
|
|
|
|
RECRUIT 8-10 YEAR OLDS
DO NOT RECRUIT MORE THAN ONE CHILD PER FAMILY
RECRUIT NO MORE THAN TWO CHILDREN FROM THE SAME SCHOOL
RECRUIT ROUGHLY ½ BOYS AND ½ GIRLS FOR EACH GROUP
Has/have your
child(ren) ever participated in a focus group or been paid to be
part of a discussion group?
Yes |
[ ] |
Continue |
No |
[ ] |
Skip to Q7 |
How recently did
he/she/they participate in a focus group?
Less than 6 months ago |
[ ] |
Terminate |
6 months ago or longer |
[ ] |
Continue |
Do you think your child would like to participate in a focus group discussion?
Yes |
[ ] |
Continue |
No |
[ ] |
Terminate |
Do you or your child(ren) have any health condition where you have to eat a special diet, cannot eat certain foods or have a diet prescribed by your doctor?
No…………………. |
[ ] |
Continue |
Yes …….…….…… |
[ ] |
Terminate |
Including yourself, how many people currently live in your household??
__________ [Record answer]
What is your total annual household income? [Do not read list]
Less than $20,000………… |
1 |
Record number below |
$20,000 - $27,000………… |
2 |
Record number below |
$27,001 - $34,000………… |
3 |
Record number below |
$34,001 - $40,000………… |
4 |
Record number below |
$40,001 - $47,000………… |
5 |
Record number below |
$47,001 - $54,000………… |
6 |
Record number below |
$54,001 - $61,000………… |
7 |
Record number below |
$61,001 - $68,000………… |
8 |
Record number below |
More than $68,000……….. |
[ ] |
Terminate |
Don’t know/Refused ……... |
[ ] |
Terminate |
Answer to question 9: ____________ Answer to question 10: _______________
Accept respondent if he/she falls into one of the following categories:
___ Has 1 person in household (Q9), and answer to Q10 is 1.
___ Has 2 people in household (Q9), and answer to Q10 is 1 or 2.
___ Has 3 people in household (Q9), and answer to Q10 is 1, 2, or 3
___ Has 4 people in household (Q9), and answer to Q10 is 1, 2, 3, or 4
___ Has 5 people in household (Q9), and answer to Q10 is 1, 2, 3, 4, or 5.
___ Has 6 people in household (Q9), and answer to Q10 is 1, 2, 3, 4, 5, or 6.
___ Has 7 people in household (Q9), and answer to Q10 is 1, 2, 3, 4, 5, 6, or 7.
___ Has 8+ people in household (Q9), and answer to Q10 is 1, 2, 3, 4, 5, 6, 7, or 8.
[INTERVIEWER, RECORD WHICH CATEGORY RESPONDENT FALLS INTO]
We would also like to have participants from various racial and ethnic backgrounds to be represented. Is your 8-10 year-old child of Hispanic or Latino origin?
No…………………. |
[ ] |
Continue |
Yes …….…….…… |
[ ] |
Continue |
Which of the following best describes your 8-10 year-old child’s/children’s race? (READ LIST. ACCEPT MULTIPLE ANSWERS)
American Indian or Alaska Native………... |
[ ] |
|
Asian ….…….……………………………. |
[ ] |
|
Black or African American …….……… |
[ ] |
|
Native Hawaiian or Other Pacific Islander.. |
[ ] |
|
White……………………………………… |
[ ] |
Recruit no more than 4* |
(Do not read) Other………………………. |
[ ] |
Terminate only if response is inarticulate |
* Using questions 11 and 12 recruit no more than 4 white, non-Hispanic respondents for each group. The remaining 6 recruits can be any mix of other races, but should not all be of one racial or ethnic group. To the extent possible, they should be a mix of African Americans and Hispanics.
Are you or your child participating in any one of the following nutrition programs? [select all that apply]
SNAP or other Food Stamp Programs………..... |
[ ] |
Record. Half of recruits must participate in at least one of these programs. |
Free- or Reduced-price School Lunch ………… |
[ ] |
|
Women, Infants, and Children Program (WIC)… |
[ ] |
AFTER THE PARENT HAS QUALIFIED THE CHILD ACCORDING TO ALL OF THE PRECEDING QUESTIONS, ASK TO SPEAK TO THE BOY OR GIRL WHO FITS THE SPECS. INFORM THE PARENT THAT HE/SHE MAY STAY ON THE LINE.
AFTER CHILD HAS COME TO THE PHONE, THE RECRUITER MUST PERSONALLY ASK THE CHILD THESE QUESTIONS.
Hello, my name is ______ and I’m glad to talk to you. I’d like to ask you a few questions. There are no right or wrong answers, just tell me what you think.
What is your name? RECORD FULL NAME ____________________________
How old are you?
The
following question will be asked to ascertain if the
respondent is articulate, outgoing and
comfortable conversing. Outgoing and
articulate respondents are critical to the success of the groups.
What is your favorite character (TV, book, movie, etc.)? Why is (INSERT CHARACTER) your favorite?
RECORD CHARACTER NAME: ________________________________________________
REASONS:
EACH CHILD MUST BE ABLE TO GIVE ANSWERS IN COMPLETE SENTENCES AND FULLY DESCRIBE WHY THE CHARACTER IS HIS/HER FAVORITE; OTHERWISE, TERMINATE.
Now, I’m going to read you some sentences. Please tell me if you think it is True, Not True, or You Don’t Know… READ ALL ANSWERS FOR EACH
|
True |
Not true |
Don’t know |
I like to tell other people what I think, even it is different from what other people think |
|
TERMINATE |
TERMINATE |
I like meeting and talking to new people |
|
TERMINATE |
TERMINATE |
I like being in groups of people |
|
TERMINATE |
TERMINATE |
RESPONDENT MUST ANSWER “TRUE” FOR ALL THREE STATEMENTS.
I would like to invite you to come to a group and talk with other children your same age. I think you’ll have fun and you will be paid for helping us with this project. Would you like to participate?
Yes |
[ ] |
Continue |
No |
[ ] |
Terminate |
If the child qualifies on all of the screening questions, tell him/her that he/she has been invited to attend a focus group discussion with other kids his/her age.
AGAIN…DO NOT RECRUIT A CHILD WHO DOES NOT WANT TO PARTICIPATE EVEN IF PARENT SAYS, “YES, HE/SHE WOULD LIKE TO.”
Ask the child to give the phone back to the parent and tell the parent that her child has qualified to attend a focus group session with other children his/her age.
To help cover costs such as transportation to the focus group site and child care, your son/daughter will be given [INSERT INCENTIVE].
Thanks for allowing your child to accept our invitation. For contact purposes, may I get your name, address, and daytime and evening phone numbers? (RECORD INFORMATION BELOW)
Name:_______________________________________________________
Street
Address:_______________________________________________
City:
__________________________ Zip
Code:
____________________________
Home Phone: ___________________ Work Phone: __________________
Group:__________________________
INSTRUCTIONS:
Please reference recruitment schedule on page 1 for age requirements
for each scheduled focus group date and time. Please ask participants
to arrive at the facility 15 minutes before the group is scheduled to
begin and give/send clear directions. Participants who need glasses
or contacts for reading should bring them to the discussion.
If
you have any questions or find out that you cannot attend the focus
group, please call ___________ at __________ so that we can find
someone to take your place.
Please note that the parents
of all participants will be asked to sign a confidentiality agreement
and parental consent form prior to participating in the group. Thank
you for agreeing to be part of our study. We look forward to meeting
you. Goodbye.
File Type | application/msword |
File Title | USDA |
Author | taryn antigone |
Last Modified By | jwilson |
File Modified | 2010-08-11 |
File Created | 2010-08-11 |