1 Ninds Healthy Brain Focus Group Screener

OMB # 0925-0678

Expiration Date: 08/2016

NINDS HEALTHY BRAIN FOCUS GROUP SCREENER

Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0678). Do not return the completed form to this address.

NINDS Healthy Brain Focus Group Overview

A TOTAL OF 9 focus groups: comprised of 3 groups per market

RECRUIT 8 respondents per group, for a show of 6

TIME: 90 minutes

SCHEDULE: TBD

Market A

• 1 group of Caucasian men and women mixed, ages 45-54

- 1 group of African American men and women mixed, ages 55-65

- 1 group of Caucasian men and women mixed, ages 45-65

Market B

• 1 group of African American men and women mixed, ages 45-54

- 1 group of Caucasian men and women mixed, ages 55-65

- 1 group of Caucasian men and women mixed, ages 45-65

Market C

• 1 group of Hispanic men and women mixed, ages 45-54

- 1 group of Hispanic men and women mixed, ages 55-65

- 1 group of Caucasian men and women mixed, ages 45-65

Interviewer: ___________________________________________________________

Date: _________________________________________________________________

Reconfirmation call: ______________________________________________________

Name of recruit: ________________________________________________________

Address: ______________________________________________________________

City: __________________________________________________________________

Zip: __________________________________________________________________

Phone: _______________________________________________________________

E-mail address: _________________________________________________________

ASK TO SPEAK TO THE MALE OR FEMALE HEAD OF HOUSEHOLD.

Hello, my name is ________________ and I’m calling on behalf of the National Institute of Neurological Disorders and Stroke at NIH. We are conducting a research study about consumers’ attitudes toward health and wellness. This is not an attempt to sell you anything.

I have a few questions to ask you to determine if you qualify for this group. If you do qualify, we will invite you to participate in a 90-minute discussion on DATE . You will receive an incentive of $40 as a thank you for your participation.

It should be a very interesting session, and we would be pleased if you could join us. Would you like to see if you qualify to participate?

(IF RESPONDENT REFUSES, THANK AND TERMINATE.)

(IF RESPONDENT AGREES) Thank you for agreeing to participate. I just have a few questions to ask you to see if you qualify.

1. CONFIRM GENDER. CHECK QUOTAS

[ ] Male (Continue)

[ ] Female (Continue)

2. First, do you or do any member of your immediate family or close friends work for any of the following types of companies? (Select one)

[ ] An advertising agency (Close)

[ ] A marketing company, market research

company, or in the marketing department

of a company (Close)

[ ] A public relations or promotions firm (Close)

[ ] A health care provider such as a hospital, physical therapist, home health care service or a doctor’s office (Close)

[ ] An insurance company (Close)

[ ] A pharmaceutical company (Close)

[ ] Refused (DO NOT READ) (Close)

3. When was the last time you participated in a market research in-depth interview or focus group? (Select one)

[ ] Never (Continue)

[ ] More than 6 months ago (Continue)

[ ] Fewer than 6 months ago (Close)

4. Would you please tell me your age? (RECORD ACTUAL AGE) _____

[ ] Under 45 (Close)

CHECK QUOTAS FOR EACH GROUP.

[ ] 45-54 (Continue)

[ ] 55-65 (Continue)

[ ] 66+ (Close)

[ ] Refused (Close)

5. Are you currently:

[ ] Employed full time (Continue)

[ ] Employed part time (Continue)

[ ] Retired/not employed outside the home (Continue)

RECRUIT A MIX ACROSS GROUPS.

6. Which of the following best describes your household’s yearly income? RECRUIT A MIX

[ ] Less than $25,000 per year (Close)

[ ] $25,000 to $49,999 per year (Continue)

[ ] $50,000 to $74,999 per year (Continue)

[ ] $75,000 to $99,999 per year (Continue)

[ ] $100,000 or more per year (Continue)

7. And for informational purposes only:

a. How would you describe your ethnicity? CHECK GROUP QUOTAS.

[ ] Hispanic/Latino (Continue)

[ ] Not Hispanic/Latino (Continue)

b. How would you describe your race? CHECK GROUP QUOTAS.

[ ] White (Continue)

[ ] Black/African America (Continue)

[ ] Asian (Close)

[ ] American Indian or Alaska Native (Close)

[ ] Native Hawaiian or Other Pacific Islander (Close)

8. What is the highest level of education you have completed? RECRUIT A MIX

[ ] Some high school or less (Close)

[ ] High school graduate (Continue)

[ ] Some college (Continue)

[ ] College graduate (Continue)

[ ] Post graduate (Continue)

9. Have you personally been diagnosed with any of the following? CHECK ALL THAT APPLY

[ ] Heart/cardiovascular disease

[ ] High cholesterol

[ ] High blood pressure MUST MENTION TO CONTINUE

[ ] Diabetes

[ ] Obesity

10.  Next, I will read you a series of statements.  Please tell me how well these statements describe your feelings.  We’ll use a scale from 1-10 where “10” means the statement “describes your feelings extremely well” and “1” means the statement “does not describe your feelings at all.”  Of course, you can also use any number in between.  READ STATEMENTS ALOUD AND RECORD RATING FOR EACH STATEMENT.

[   ]  a. If asked to describe something, I can usually do so in detail.  

[   ]  b. My friends consider me friendly and outgoing.

[   ]  c.  I am open about expressing my thoughts and feelings.

[   ]  d. I enjoy meeting and talking to new people.

[   ]  e. I am comfortable talking with others even if I never met them before.

RESPONDENTS MUST ANSWER 8, 9 OR 10 TO AT LEAST 3 OF THE STATEMENTS ABOVE TO CONTINUE.  OTHERWISE, TERMINATE.

11. My next question is a little different. Feel free to be creative and take a moment to think about your response before answering. If you had no work or family obligations, what would be your ideal way to spend a day? Why?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

RECRUIT ONLY IF RESPONDENT OFFERS AN ARTICULATE RESPONSE AND APPEARS TO ENJOY THE QUESTION. ALL RESPONDENTS MUST BE CREATIVE, DETAILED AND ARTICULATE IN THEIR ANSWERS. THE RESPONDENTS SHOULD BE ABLE TO EASILY EXPRESS THEIR THOUGHTS VERSUS SAYING “I DON’T KNOW.” RESPONDENTS SHOULD BE ABLE TO ANSWER THE QUESTION FREELY WITHOUT RECRUITER HAVING TO PROBE TOO MUCH.

PLEASE LISTEN FOR CREATIVE THOUGHTS, DESCRIPTIVE WORDS AND EXPRESSIONS. IF RESPONDENTS ARE QUIET, HARD TO HEAR, NOT FORTHCOMING WITH THEIR RESPONSES, HAS LOW ENERGY, IS HESITANT, CONFUSED OR MUMBLES, THEN PLEASE THANK AND TERMINATE.

PLEASE BE SURE THE RESPONDENT CAN SPEAK CLEAR ENGLISH AND WOULD BE AN OVERALL GOOD PARTICIPANT TO INTERVIEW.

CHECK ALL THAT APPLY:

[ ] Answers spontaneously

[ ] Very sure of self

[ ] Enthusiastic

[ ] Carries on a good conversation

[ ] Does not have speech problem (stutters, slurs, mumbles, accent)

IF SATISFIED, FINALIZE INVITATION

You are eligible to participate in our in-person discussion on health and wellness. As I said, this is not an attempt to sell you anything--this is strictly a research project. It is also an opportunity to express your thoughts, opinions and ideas to an organization that is interested in what you have to say. I think you will find the discussion and topic to be fun and interesting. The discussion will last 90 minutes, and an incentive of $40 will be provided as a thank-you for your participation.

May we count on your attendance?

[ ] Yes (Continue) Check group times above. Write in time of group______________

[ ] No (Close)

Do you wear glasses or corrective lenses?

[ ] Yes (Continue) READ: Please bring or wear your glasses/lenses to the group

[ ] No