Form 1 Fatherhood Screener

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

Fatherhood Screener - Final

NRFC

OMB: 0970-0401

Document [doc]
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Qualitative Research

SCREENER

Feb 5-6, 2013

Focus Groups


Chicago and Tampa


Tuesday February 5th Chicago

Full Time Dad-General Market

1:00pm to 3:00pm

Break

3:00pm to 4:00pm

Non-Custodial-General Market

4:00pm to 6:00pm

Non-Custodial-Hispanic-Spanish Dominant

6:15pm to 8:15pm

Wednesday February 6th Tampa

Full Time Dad-General Market

2:00pm to 4:00pm

Break

4:00pm to 5:00pm

Non-Custodial-General Market

5:00pm to 7:00pm

Non-Custodial-General Market

7:15pm to 9:15pm






Hello, my name is _________ from XYZ Research. Today, we are interested in talking with dads across the US about their daily routines, family activities and attitudes about being a dad. Is there a dad in your household?


If no dad present, thank and terminate

If there is a dad present, continue with screening questions



1.

Have you ever participated in a research discussion group, focus group or one on one interview?




  1. Yes [ ] CONTINUE

2. No…………………….........……………...[ ] SKIP TO Q3.


2b.

When was the last time you participated in a research discussion group, focus group, or one on one interview?




RECORD ANSWER IF WITHIN THE PAST 6 MONTHS,
THANK AND TERMINATE.


2C.


How many focus group discussions or one on one interviews have you participated in in the past 12 months?





None 1 SKIP TO Q3

1 to 2 2 ASK 2D

3 or more 3 TERMINATE




2D. What was the topic of discussion during the interview had in the last 12 months


Automobiles 1 CONTINUE

Household products 2 CONTINUE

Beauty products 3 CONTINUE

Fatherhood/family matters 4 TERMINATE

Weight loss 5 CONTINUE

Food products 6 CONTINUE

IF THEY MENTION Fatherhood/Family matters TERMINATE




3. How many children do you have that are under the age of 18 years of age?

RECRUIT A GOOD MIX


( ) One……………….CONTINUE

( ) Two to three…CONTINUE

( ) Four or more…CONTINUE

( ) None………………TERMINATE



3a. How old are your children?______ _______ _____ _____ _____ _____


AT LEAST ONE CHILD MUST BE BETWEEN 3 AND 17--GET A GOOD MIX OF AGES


4. Are any of your children disabled or have special needs?


( ) Yes

( ) No


Just to make sure we are talking to a wide range of people in your area, please tell me if you are?


RECRUIT GOOD MIX FOR GENERAL MARKET GROUPS, WITH NO MORE THAN 2 ENGLISH PROFICIENT HISPANICS IN EACH GENERAL MARKET GROUP, SINCE WE HAVE DEDICATED HISPANIC GROUPS




5. What do you consider to be your ethnic background?


Caucasian or white 1 SKIP TO Q6

African American 2 SKIP TO Q6

Hispanic or Latino 3 CONTINUE

Asian 4 SKIP TO Q6

Other_____________ 5 SKIP TO Q6

Refused 6 TERMINATE

All GENERAL MARKET respondents must be proficient and able to communicate in English.

5ª. ¿Dígame, en qué idioma prefiere hablar? LEER LISTA. ACEPTAR SOLO UNA RESPUESTA.

(Tell me, which language do you prefer speaking?) READ LIST. ACCEPT ONLY 1 RESPONSE.


Español / Spanish

  • Consider for Spanish Dominant Group

Español e inglés por igual

Spanish and English equally

  • Consider for Spanish Dominant Group

Inglés / English

  • Consider for General Market Group

Otro idioma / Another language

  • Terminar / Terminate



5b. ¿Qué idioma habla usted la mayor parte del tiempo en su hogar? LEER LISTA. ACEPTAR SOLO UNA RESPUESTA.

(Which language do you speak at home most of the time?) READ LIST. ACCEPT ONLY 1 RESPONSE.


Unicamente español

Only Spanish

  • Consider for Spanish Dominant Group

Español más que inglés

Spanish more than English

  • Consider for Spanish Dominant Group

Español e inglés por igual

Spanish and English equally

  • Consider for Spanish Dominant Group

Inglés más que español

English more than Spanish

Consider for General Market Group

Unicamente inglés

Only English

Consider for General Market Group

Otro idioma / Another language

  • Terminar / Terminate


Hispanic Spanish Dominant Group: Ensure that respondent is VERY COMFORTABLE speaking Spanish. Respondents who are not very comfortable speaking SPANISH will not be allowed into the groups

English Dominant Hispanics—Limit 2 per group for General Market Groups: Ensure they are VERY COMFORTABLE speaking English. Respondents who are not very comfortable speaking English will not be allowed into the General Market Groups


6. Where do your children reside? RECRUIT GOOD MIX.


IF RESPONDENT IS UNSURE HOW TO ANSWER, CAN CLARIFY THAT WE WOULD LIKE TO KNOW WHERE THE CHILD SPENDS THE MAJORITY OF HIS/HER TIME


( ) With me and my spouse/significant other

( ) With me, no spouse/significant other

IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS CUSTODIAL DAD

( ) With my spouse/significant other

( ) With some other family member

IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS

NON-CUSTODIAL DAD – ASK TIME SPENT WITH CHILDREN QUESTION BELOW


**NOTE: NEED TO DISCUSS WITH MODERATOR HOW TO QUALIFY DADS IF THEY LIVE WITH ONLY SOME OF THEIR CHILDREN**


7. You indicated that your children don’t reside with you. How often would you say you spend time with your children?


( ) Less than once a month – TERMINATE

( ) Once a month

( ) Two-four times a month

( ) Five times or more a month




8. What is your current marital status? RECRUIT GOOD MIX


( ) Single

( ) Married

( ) In a committed relationship/live with significant other

( ) Divorced

( ) Separated

( ) Widowed



9. Are currently employed outside the home or attending school/college? Would you say you: RECRUIT GOOD MIX


( ) Work full time (40+ hours a week) – ASK OCCUPATION QUESTION

( ) Work part time (less than 40 hours a week) – ASK OCCUPATION QUESTION

( ) Student

( ) Not currently employed

( ) Retired



10. What is your present occupation? ______________________________



What is your current, annual approximate household income?

RECRUIT GOOD MIX OF INCOME


( ) Under $30,000

( ) $30,000 to $49,999

( ) $50,000 to $74,999

( ) $75,000 and above



11. Into which of the following age brackets do you fall? RECRUIT GOOD MIX OF AGES


( ) 18 or Younger -- TERMINATE

( ) 18-24

( ) 25-34

( ) 35-39

( ) 40-45

( ) 46-49

( ) 50-55

( ) 56+ TERMINATE


12. What is your educational background? RECRUIT GOOD MIX


( ) Less than HS

( ) HS Grad (HS diploma, GED, or equivalent)

( ) Some College

( ) College Graduate

( ) Master’s Degree













ARTICULATION QUESTION:

If you could go anywhere in the world to visit and money was no object, where would you go and what would you do there?







INVITATION


We would like to invite you to a group discussion. The discussion will last about two hours on [INSERT DATE/TIME/LOCATION].We don’t have anything to sell you and are only interested in your honest opinions. To thank you for your cooperation, we will give you a gift of $XX in cash


The groups will be small. If you agree to attend it is very important that we be able to count on you. May we count on your participation?


Can we count on your participation?


1

Yes

Continue

2

No

TERMINATE



We’d like to send a confirmation letter and a map with directions. May I have your name and the address? May I have your daytime phone so we can call to make sure you received the letter?


Respondent’s Name



Address



City, State Zip



Daytime Phone


Best time to call:


Thank you. I have a couple of final things to explain. First, it would be best if you did not bring a friend or spouse or children, as there isn’t room to accommodate them. Also, we’d like you to come early, but not too early. If you could come 10 to 15 minutes in advance, you can have some snacks and refreshments and your wait won’t be long before we begin. Do you have questions?


If you use eyeglasses for reading printed materials, please bring them with you. Also, under research industry rules, you will be asked to provide proof of identification, so please bring ID with you.


Please call us here at [FACILITY NAME] at [PHONE NUMBER] if you have questions.


Upon confirmation all respondents are to be re-screened


Confirmed : ________________ Date confirmed: ____________________


  • For groups -- No Pairs may be close relatives or reside in the same household.

  • Using your own good judgment, we expect verbal, out-going respondents.

  • Respondents are to arrive at least 15 minutes prior to scheduled group.


File Typeapplication/msword
File TitleFCIC Screener
AuthorCampbell-Ewald
Last Modified ByPatty Goldman
File Modified2013-01-03
File Created2013-01-03

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