Hello, my name is xxx and I work for Synovate, a local research firm. We’re doing research for the Food and Drug Administration about dietary supplements. If you are eligible and you agree to participate, we will give you $40 to complete an in-person interview that should last about an hour. In order to find out if you are eligible to be interviewed, I’d like to get some background information.
Before I proceed, may I ask to which of the following age group do you belong?
18 years or younger :___: [THANK AND END]
19 to 35 years old :___: [THANK AND END]
36 to 50 years old :___: [THANK AND END]
51 to 65 years old :___:
66 years or older :___:
1. Do you work either full- or part-time in a healthcare company or a food or nutrition company?
YES :___: [THANK AND END]
NO :___:
2. In an average week, about how many hours would you say you use the Internet?
NONE :___: [THANK AND END]
1 HOUR OR MORE :___:
DON’T KNOW :___: [THANK AND END]
3. [RECORD GENDER. IF NOT OBVIOUS, ASK; RECRUIT 4-5 OF EACH]
Are you male or female?
FEMALE :___:
MALE :___: [RECRUIT A MIX]
4. Have you ever taken a multi-vitamin, mineral, or other dietary supplement?
YES :___:
NO :___:
5. Have you ever taken a selenium mineral supplement?
YES :___:
NO :___:
6. What is the highest level of education that you have completed? [CODE INTO ONE OF THE FOLLOWING CATEGORIES]
LESS THAN A HIGH SCHOOL DIPLOMA :___:
HIGH SCHOOL GRADUATE OR GED :___:
SOME COLLEGE, ASSOCIATES DEGREE :___:
COLLEGE GRADUATE :___:
ADVANCED DEGREE :___:
[RECRUIT 2 WITH HIGH SCHOOL DIPLOMA OR LESS]
7. Are you of Hispanic or Latino origin?
YES: :
NO: :
8. What is your race? You may choose one or more categories as they apply.
WHITE :___:
BLACK OR AFRICAN AMERICAN :___:
ASIAN:___:
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER:___:
AMERICAN INDIAN OR ALASKA NATIVE
SOME OTHER RACE (specify)_______________________________________
[RECRUIT 3-4 WHO ARE NOT WHITE]
9. What is your occupation?
______________________________________________________________________
INVITATION
[IF ELIGIBLE AND QUOTA REMAINS UNFILLED]
Thank you for answering all my questions. I’d like to invite you to participate in an in-person interview that will take about an hour to complete. We’ll pay you $40 for your time with us. Let me give you some available times and you tell me what would be best for you.
INTERVIEW DATE AND TIME:
The interview will be held at (location). I would like to send you directions. Where can I send them? Also, may I please have your phone number in case we need to get hold of you for any reason?
COLLECT RESPONDENT NAME, ADDRESS (AND EMAIL ADDRESS, IF APPLICABLE) AND PHONE
Name: _____________________________________________________________
Address: _____________________________________________________________
City: _________________________________ State: ______ Zip Code: __________
Phone: ________________________________________
E-mail: ________________________________________
In case you need to contact me for any reason, you can reach me at 1-800-xxx-xxxx.
| File Type | application/msword |
| File Title | Appendix C |
| Author | serena.lo |
| Last Modified By | Lo, Serena |
| File Modified | 2012-12-18 |
| File Created | 2012-12-18 |