Form 1 Small Group Discussion Screener

Appendix B: Small Group Discussion Screener

UCARE4LIFE Message Library

INTRODUCTION AND Verbal Consent To be Screened

[IF REACH VOICEMAIL] “Hello, my name is __________ and I’m from RTI International. I’m trying to reach [FIRST NAME] who agreed to be contacted about a research study we are conducting about young people and text messages. Please give me a call back at your earliest convenience at [NUMBER.]

READ: “Hello, my name is __________ and I’m from RTI International, a nonprofit research company in North Carolina. I’m trying to reach [FIRST NAME] who agreed to be contacted about a research study we are conducting about text messages. May I speak to [FIRST NAME]?

[IF RESPONDENT NOT HOME OR UNAVAILABLE] When would be a good time to call again? Thank you for your time.

[ONCE SPEAKING TO RESPONDENT] We are inviting people to be in a small group interview that is part of a research study about cell phone messages for people with HIV. RTI is conducting the study. The Health Resources and Services Administration, or HRSA, a federal health agency, is sponsoring this study.

In order to see if you are eligible to be in the study we need to ask you some questions. Some of these questions may be personal such as asking about your HIV status. It is your choice to answer the questions. Your answers will be kept private. You can choose not to answer a question or stop at any time and withdraw from the screening process. The questions will take less than 10 minutes to complete.

If you are eligible for this study and are interested, we will ask you to participate in a group discussion about text messages for people with HIV. We will ask you if this assignment is okay with you. Everything you tell us in the interview will be private. We will never link your name with any of your comments. If you join a small group that meets for 2 hours, we will give you $50 for your time and effort. Each group needs a minimum of two people and so if two or more people do not show up, you will receive $25 and the small group interview will not be held.

May I ask you the questions to see if you are eligible now?”

Yes  CONTINUE

No  TERMINATE and READ: THANK YOU!

SECTION 1

GATEWAY

1.1. How old are you?

INELIGIBLE	Under 15  SKIP to Section 5	1
	15-17 RECORD AGE & CONTINUE to Section 2 Adolescents	2
	18-24  RECORD AGE & SKIP to Section 3	3
INELIGIBLE	Over 24  SKIP to Section 5	4
INELIGIBLE	Don’t know  SKIP to Section 5	5
INELIGIBLE	Decline to answer  SKIP to Section 5	6

SECTION 2

ADOLESCENT ASSENT

2.1. Before we begin, I have two questions I want to ask you to make sure you understand what I just read to you. [Do not correct person on answers until the end of the 2 question series.]

2.1a. Do you have to answer all of the questions that I ask you?

INCORRECT	Yes	1
CORRECT	No	2
	Don’t Know	3
	Decline to answer	4

2.1b. Am I going to ask you about your HIV status?

CORRECT	Yes	1
INCORRECT	No	2
	Don’t Know	3
	Decline to answer	4

SCORING

• If all answers correct, CONTINUE to SECTION 3.

• If one (1) or more answers incorrect, reread the relevant portion of the verbal consent that pertains to the question and re-ask the question. If correct, CONTINUE. Otherwise, SKIP TO SECTION 5.

SECTION 3

ALL ELIGIBLE AGES – 15 to 24

3.1. Are you Hispanic or Latino?

	Yes  CONTINUE	1
	No  SKIP to 3.2	2
INELIGIBLE	Don’t Know  SKIP to Section 5	3
INELIGIBLE	Decline to answer  SKIP to Section 5	4

3.1a. What language are you most comfortable using with friends and family? [READ RESPONSES 1-6 AND MARK ONLY ONE]

English  CONTINUE	1
Spanish  CONTINUE	2
English and Spanish equally  CONTINUE	3
Other: [RECORD]:  CONTINUE	4
Don’t know  CONTINUE	5
Decline to answer  CONTINUE	6

3.2. What is the category that best describes your racial background? [READ RESPONSES 1-9 AND MARK ONLY ONE]

	American Indian or Alaskan Native  CONTINUE	1
	Asian  CONTINUE	2
	Black or African American  CONTINUE	3
	Native Hawaiian or Other Pacific Islander  CONTINUE	4
	White  CONTINUE	5
	Other: [RECORD]:  CONTINUE	6
INELIGIBLE	None  SKIP to Section 5	7
INELIGIBLE	Don’t know  SKIP to Section 5	8
INELIGIBLE	Decline to answer  SKIP to Section 5	9

3.3 What is your gender? [Read ALL responses. Do not assume.]

	Male  SKIP to 3.4	1
	Female  SKIP to 3.4	2
	Transgender or Transsexual  CONTINUE	3
INELIGIBLE	Decline to answer  SKIP to Section 5	4

3.3a. Are you a male-to-female or female-to-male transgender or transsexual person?

	Male to Female CONTINUE	1
	Female to Male  CONTINUE	2
INELIGIBLE	Decline to answer  SKIP to Section 5	3

3.4 Have you ever been tested for HIV?

	Yes  CONTINUE	1
INELIGIBLE	No  SKIP to Section 5	2
INELIGIBLE	Don’t know  SKIP to Section 5	3
INELIGIBLE	Decline to answer  SKIP to Section 5	4

3.5a. The next question is about the result of your HIV test. What was the result of your most recent HIV test? (Read options.)

	I tested positive for HIV  CONTINUE	1
INELIGIBLE	I tested negative for HIV  SKIP to Section 5	2
INELIGIBLE	My results were unclear / Don’t Know  SKIP to Section 5	3
INELIGIBLE	I never got my results  SKIP to Section 5	4
INELIGIBLE	Decline to answer  SKIP to Section 5	5

3.5b When did you first test positive?

	RECORD DATE (mm/yy):__________  CONTINUE	1
INELIGIBLE	Don’t Know  SKIP to Section 5	2
INELIGIBLE	Decline to answer  SKIP to Section 5	3

3.6a Do you have your own cell phone?

	Yes  CONTINUE	1
INELIGIBLE	No  SKIP to Section 5	2
INELIGIBLE	Other - RECORD REASON: _______________________________ (e.g., share one, sometimes, used to, planning to…)  SKIP to Section 5	3
INELIGIBLE	Don’t know SKIP to Section 5	4
INELIGIBLE	Decline to answer  SKIP to Section 5	5

3.6b Do you use your cell phone to send or receive text messages?

	Yes  CONTINUE	1
INELIGIBLE	No  SKIP to Section 5	2
INELIGIBLE	Other - RECORD REASON: _______________________________ (e.g., doesn’t have that feature, don’t pay for that service)  SKIP to Section 5	3
INELIGIBLE	Don’t know SKIP to Section 5	4
INELIGIBLE	Decline to answer  SKIP to Section 5	5

3.7 Now I am going to ask you to describe your sexual identity. Would you describe yourself as [READ]:

Homosexual or “gay”	1
Bisexual	2
Heterosexual or “straight”	3
Other	4
Don’t know	5
Decline to answer	6

SECTION 4

INVITATION FOR ELIGIBLE 15 to 24 year old PARTICIPANTS

READ: “We want to invite you to be in a small group interview about using test messages to help HIV positive youth and young adults stay healthy. You will get together for about 2 hours to talk about your thoughts on this topic. We will also ask for your opinions on some text messages we have developed. You will be in a group of up to 3 other people with HIV. We will be audio-recording the group. If you choose to attend, whatever you say will be kept private. Before the group, we will ask all members to keep what is said private. If you feel more comfortable, you can choose to use a false name or alias within the group. You will be given $50 to for your time and effort. If only one person comes to the scheduled group, we will not conduct the group. However, you will be given $25 for travel costs.

In a minute, I will need to ask you for your first name and phone number so that we can call to remind you about the appointment. This information is necessary for you to join. I will also ask you for your email address so we can send you directions to the location. Finally, I will also ask the month and year of your birth to help us keep track of who attends the groups. This information is also necessary. All of your contact information will be destroyed within 2 weeks after the group.”

4.1a. Are you interested in participating?

	Yes  RECRUIT as HIV POSITIVE 15 to 17 year old ADOLESCENT. Segment by gender (NOTE AGE IN 4.1d)	1
	Yes  RECRUIT as HIV POSITIVE 18 to 24 year old. Segment by gender (NOTE AGE IN 4.1d)	2
INELIGIBLE	No  Skip to Section 5	3
INELIGIBLE	Don’t know  Skip to Section 5	4
INELIGIBLE	Decline to answer  Skip to Section 5	5

4.1b [ASK FOR TRANSGENDER ONLY] We will have separate groups for males and females. Which group would you feel most comfortable in?

	Males CONTINUE and place into one of the A groups (4.1d)	1
	Females CONTINUE and place into one of the groups (4.1d)	2

4.1c [ASK FOR HISPANIC ONLY] We will have separate groups conducted in English and Spanish. Which group would you feel most comfortable in?

	English  CONTINUE and place into one of the C groups (4.1d)	1
	Spanish  CONTINUE and place into one of the D groups (4.1d)	2

4.1d [DON’T ASK – USE FOR QUOTAS]

	English (C)				Spanish (D)
		15-17	18-24			15-17	18-24
Male (A)	AC			1	AD			3
Female (B)	BC			2	BD			4

READ: May I schedule you to come?

Yes	Confirm the date and time of the group, and give the address of and directions to the facility. Read: If you arrive more than 30 minutes late to the group, you will not be able to participate.
No	READ: “If you decide that you want to attend, please call us at [insert phone number]. Thank you for your time.”
Don’t Know / Not Sure / Declines to answer	READ: “If you decide that you want to attend, please call us at [insert phone number]. Thank you for your time.”

READ: “In order for us to check you in when you arrive for your appointment, you will be asked your first name and date of birth. May I have your first name and your date of birth—only month and year?”

FIRST NAME: _____________________________________________________________

BIRTH MONTH/YEAR: _______________________________________________

READ: “A day or so before your appointment, we will call you to re-confirm the time. We will need your phone number to do this. What is the best time to reach you? What is the best telephone number to reach you at that time?”

BEST TIME TO BE REACHED: _______________________________________________

BEST PHONE NUMBER: ________________

READ: “Is there another time and number we can try if we miss you?”

ALTERNATE TIME TO BE REACHED:_________________________________________

ALTERNATE PHONE NUMBER: ___

READ: Can we leave a message? We will not leave any details in the message, but will remind you of the appointment and ask you to call us back to confirm.” __ Yes ____No____

***WITHOUT A PHONE NUMBER—PERSON DOES NOT QUALIFY***.

READ: “We would also like to be able to send you a reminder letter or e-mail with directions.  If you prefer not to receive an email from us, we can provide directions over the phone. Which do you prefer? What is your E-mail address? We will never send you anything other than the reminder and directions..”

E-MAIL ADDRESS: __________________

READ: “Your participation in this project is very important. If for some reason you will not be able to attend, please let us know right away. You can call us anytime at [insert phone number], and if we are not here, please leave a message. Thank you.”

To be completed by recruiter
Eligible and scheduled – NOTE GROUP NAME/TIME/DATE	YES	NO
Eligible, but not scheduled: NOTE REASON	YES	NO
Eligible, but refused to participate: NOTE REASON	YES	NO
Ineligible	YES	NO

SECTION 5

CLOSING FOR INELIGIBLE PERSONS

READ: “Thank you very much for taking the time to answer my questions. However, at this time you do not meet the eligibility criteria for this study. The criteria to participate were decided earlier by the project leaders. Thank you for being willing to help us.”